Federal Policy
CMS Proposes Verification Rules to Curb ACA Exchange Fraud
CMS has issued a proposed rule to implement a law aimed at combating fraud in Affordable Care Act exchanges by adding new applicant verification requirements. The rule targets improper enrollments and subsidy payments tied to inaccurate income or eligibility data on the exchanges. Comments will be accepted for a public comment period following publication in the Federal Register. CMS frames the proposal as a taxpayer protection measure intended to tighten eligibility checks before coverage or subsidies are approved.
Why it mattersState Medicaid agencies rely on coordinated eligibility and verification systems with the exchanges, so tighter federal verification standards could affect account transfer processes, dual-enrollment checks, and eligibility redetermination workloads.
Also covered by:cms.gov