The Trump administration has begun restoring Affordable Care Act coverage for a small number of people removed during a federal anti-fraud operation, after insurers found that some cancellations should not have occurred. More reinstatements could follow as consumers discover they are uninsured when they try to use their plans.
The action affected plans sold through the federal marketplace, including coverage in states such as Texas, Florida, Louisiana and Mississippi.
The administration said its review targeted enrollments it considered fraudulent, improper or unauthorized, including cases involving missing Social Security numbers, questionable income information and people allegedly enrolled without their knowledge.
Insurers were involved in reviewing the cases before cancellations were finalized, but CMS has not publicly released a complete list of the companies it contacted. Oscar Health disclosed that it expected 250,000 to 300,000 of its members to be retroactively disenrolled in connection with CMS program-integrity requirements and fraud, waste and abuse rules. Its chief executive said the company had reached some people on the government’s list, though he did not say how many.
The broader crackdown also includes the removal of subsidies for about 189,000 people identified as having duplicate Medicare, Medicaid or Children’s Health Insurance Program coverage, or as deceased. People identified through duplicate-coverage checks generally receive 30 days to dispute the finding, and CMS says they can appeal later or regain subsidies if other coverage is ending.
The administration’s actions come after ACA enrollment fell by nearly 3 million early this year, following the expiration of enhanced subsidies that had expanded coverage during the Biden presidency. Federal officials have also credited stricter enrollment checks and the elimination of a special year-round enrollment pathway for the decline.
The cancellations have drawn questions about whether the government’s criteria distinguish fraudulent applications from legitimate people who failed to respond. A missing Social Security number can signal an improper enrollment, but it can also reflect an oversight or a situation in which a number was not required for a child on an application. People may also ignore calls, emails or mailed notices even when they are legitimately enrolled.
Health insurance agents and policy specialists have supported efforts to remove unauthorized enrollments while warning that valid enrollees could be swept up. The dispute now centers on how many people were wrongly removed, how quickly insurers can identify them and whether the administration will disclose enough information to show how the decisions were made.