A new report from the Centers for Medicare & Medicaid Services (CMS) has revealed that millions of individuals were enrolled in multiple publicly funded health plans during 2024, raising significant concerns about duplicate coverage and unnecessary spending within the Medicaid program.
Duplicate Medicaid enrollments are costing the program billions of dollars. According to the data, 1.2 million people were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) across more than one state. At the same time, another 1.6 million individuals had simultaneous coverage under both Medicaid and an ACA Marketplace plan.
For Medicaid Managed Care Organizations (MCOs) and their Coordination of Benefits (COB) and Third-Party Liability (TPL) teams, this news reinforces a challenge they face daily: the issue of improper payments. These departments work diligently to ensure accurate coverage identification and prevent unnecessary claim payments. However, despite their rigorous efforts, many duplicate enrollments are only uncovered after services have been provided and payments have been made, forcing plans to engage in resource-intensive recovery efforts.
Outdated systems, slow eligibility feeds, and fragmented data between state and federal programs make it nearly impossible for plans to identify overlapping enrollments in real-time, proactively.
“Plans aren’t failing to do the work. They’re being asked to manage a national-scale eligibility challenge without the modern tools required to solve it,” noted one industry expert.
These enrollment overlaps have profound implications: inefficient spending of taxpayer dollars, disrupted provider reimbursements, and confusion for members navigating their benefits. More importantly, they highlight the limits of current infrastructure and the need for modern, integrated, real-time data.
To address these gaps, CMS’s findings underscore what Medicaid plans have been emphasizing for years—technology and data modernization are essential. Many MCOs have developed internal processes to detect suspicious enrollment patterns, but without comprehensive, up-to-date data, true cost avoidance remains beyond reach.
Maintaining Medicaid’s role as a dependable safety net will require coordinated investment in new systems that allow for interoperability, consistent eligibility tracking, and early detection of dual coverage. These tools will enable plans to prevent improper payments instead of recovering them after the fact.
With 2.8 million overlapping enrollments identified in a single year, the urgency is clear. Medicaid plans are already committed to protecting program resources. Now, they need the tools and data to support a proactive, prevention-first approach.
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