Reducing Duplicate Enrollment under the Medicaid and Chip Programs
Section 71103 · Sec. 71103 ·
What this chapter is about
This part stops a person being on Medicaid in two states at once. States must send monthly data to a new federal system. They must also keep addresses up to date from named sources. The system is due by October 1, 2029.
“beginning not later than January 1, 2027, in the case of 1 of the 50 States and the District of Columbia, for a process to regularly obtain address information for individuals enrolled under such plan (or a waiver of such plan) in accordance with subsection (vv); and”
The section inserts a new paragraph (88) into section 1902(a) of the Social Security Act (42 U.S.C. 1396a) requiring a State plan to provide, by January 1, 2027 for the 50 States and the District of Columbia, a process to regularly obtain enrollee address information, and, by October 1, 2029, to send the Secretary's new system at least monthly and at each eligibility determination the enrollee's social security number where one is required and any other information the Secretary needs, to use that system to stop simultaneous enrollment, and where the system shows a person is enrolled in another State to take appropriate action to find out where the person lives and disenroll them if they do not live in the State, unless an exception applies.
What the document actually says
“beginning not later than January 1, 2027, in the case of 1 of the 50 States and the District of Columbia, for a process to regularly obtain address information for individuals enrolled under such plan (or a waiver of such plan) in accordance with subsection (vv); and”
That sentence, in plain words
By January 1, 2027 the state must have a way to keep addresses current. That covers people on the plan or under a waiver. Only the 50 states and the capital are covered.
What this is about
From October 1, 2029 more is required. The state must send data to a federal system each month. It must use that system to stop double signup.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 71103 in the PDF
What the document says
“Not later than October 1, 2029, the Secretary shall establish a system to be utilized by the Secretary and States to prevent an individual from being simultaneously enrolled under the State plans (or waivers of such plans) of multiple States.”
The section adds a new subsection (uu) to section 1902 of the Social Security Act requiring the Secretary, by October 1, 2029, to build a system the Secretary and States use to stop simultaneous enrollment in more than one State. The system must take in what States send and at least monthly tell a State whether a person enrolled or seeking to enroll there is enrolled in another State. The Secretary must set standards to limit and protect the information and keep it private.
What the document actually says
“Not later than October 1, 2029, the Secretary shall establish a system to be utilized by the Secretary and States to prevent an individual from being simultaneously enrolled under the State plans (or waivers of such plans) of multiple States.”
That sentence, in plain words
The Secretary must build a system by October 1, 2029. It is used by the Secretary and the states. It stops a person being on the rolls in two states at once.
What this is about
The system takes in what states send. It reports back at least once a month. The Secretary must set rules to keep the data private.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Administrator of the Centers for Medicare & Medicaid ServicesHow: statuteSec. 71103 in the PDF
What the document says
“for fiscal year 2026, $10,000,000 for purposes of establishing the system and standards required under this subsection, to remain available until expended; and”
The section appropriates $10,000,000 for fiscal year 2026 to build the system and set the standards, and $20,000,000 for fiscal year 2029 to maintain it, each to remain available until expended.
What the document actually says
“for fiscal year 2026, $10,000,000 for purposes of establishing the system and standards required under this subsection, to remain available until expended; and”
That sentence, in plain words
Ten million dollars goes to setting up the system. That is for fiscal year 2026. The money stays there until it is spent.
What this is about
A further $20 million comes in fiscal year 2029. That keeps the system running. Both sums stay until they are spent.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“Mail returned to the State by the United States Postal Service with a forwarding address.”
The section adds a new subsection (vv) to section 1902 of the Social Security Act requiring the address process to draw on reliable data sources and to take the actions the Secretary specifies where an address changes. The reliable sources are mail returned by the Postal Service with a forwarding address, the National Change of Address Database, a managed care entity or prepaid health plan under contract where the address came straight from or was checked with the person, and other sources the State identifies and the Secretary approves.
What the document actually says
“Mail returned to the State by the United States Postal Service with a forwarding address.”
That sentence, in plain words
One source is mail sent back by the post office. It must carry a forwarding address.
What this is about
A national change of address list is another. A health plan under contract is a third. The state may name others if the Secretary agrees.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: managed care entities and prepaid health plansHow: statuteSec. 71103 in the PDF
What the document says
“shall provide that such entity or plan shall promptly transmit to the State any address information for an individual enrolled with such entity or plan that is provided to such entity or plan directly from, or verified by such entity or plan directly with, such individual.”
The section adds a new subsection (j) to section 1932 of the Social Security Act requiring every contract from January 1, 2027 with a managed care entity or a prepaid inpatient or ambulatory health plan to require the plan to pass the State any address information it gets straight from the person or checks with them. It also amends section 2103(f)(3) so that the duty carries into the children's health program.
What the document actually says
“shall provide that such entity or plan shall promptly transmit to the State any address information for an individual enrolled with such entity or plan that is provided to such entity or plan directly from, or verified by such entity or plan directly with, such individual.”
That sentence, in plain words
The plan must pass any address on to the state. It must do so at once. The address must have come from the person or been checked with them.
What this is about
Every such contract must say so. The rule starts on January 1, 2027. It also reaches children's health plans.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“Section 1902(a)(88) (relating to address information for enrollees and prevention of simultaneous enrollments).”
The section inserts a new subparagraph (H) into section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) applying the new address and duplicate enrollment duties to the Children's Health Insurance Program, and redesignates the subparagraphs that follow.
What the document actually says
“Section 1902(a)(88) (relating to address information for enrollees and prevention of simultaneous enrollments).”
That sentence, in plain words
The new duty is added to a list for children's health cover.
What this is about
That list names Medicaid rules that also apply there. So the same address duties bite. So does the bar on double signup.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
Each distinct thing the section does: require the State to keep addresses current and to feed the new system, require the Secretary to build that system with privacy standards and funding, set out the reliable address data sources, require managed care plans to pass addresses on, and carry the duty into the children's health program.
The punctuation and redesignation edits that make room for the new paragraphs, and the conforming change to the older data matching requirement.
The section works by amending sections 1902, 1903, 1932, 2103 and 2107 of the Social Security Act, none of which is indexed here, so how enrollment otherwise works cannot be checked against anything on this site.
