To amend the Patient Protection and Affordable Care Act to identify individuals dually enrolled in Medicaid or CHIP and an Exchange.
- Bill Number
- H.R. 6516
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-12-09: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-01-07T17:24:41Z
AI-Generated Summary
Purpose The legislation amends the Patient Protection and Affordable Care Act to create a system for detecting individuals enrolled in both a qualified health plan through an Exchange and Medicaid or the Children's Health Insurance Program (CHIP). Its goal is to prevent these individuals from improperly receiving federal premium tax credits or cost-sharing reductions.
Key Provisions
- Requires the Secretary of Health and Human Services to establish a data-matching program within 60 days of enactment.
- The program must compare Exchange enrollment data with Medicaid and CHIP enrollment data at least quarterly using the Public Assistance Reporting Information System (PARIS) or a successor system.
- Directs the Secretary to take enforcement actions, such as notifying Exchanges and the Secretary of the Treasury, to end premium tax credits under Internal Revenue Code section 36B and cost-sharing reductions under ACA section 1402 for identified dual enrollees.
Significant Changes to Existing Law This bill adds a new paragraph (8) to section 1311(c) of the Affordable Care Act. It introduces a mandatory, recurring federal data cross-check requirement that did not previously exist in statute for this specific purpose.
Potential Impacts
- Government agencies: Increases administrative workload for the Department of Health and Human Services, state Medicaid and CHIP agencies, ACA Exchanges, and the Department of the Treasury to process matches and adjust subsidy payments.
- Citizens: Individuals found to be dually enrolled may lose eligibility for federal subsidies, potentially requiring them to repay improperly received assistance or switch coverage.
- International relations: No direct effects.
Main Stakeholders Affected
- Individuals enrolled in both Medicaid/CHIP and an Exchange plan.
- State Medicaid and CHIP programs.
- ACA Exchanges and participating health plans.
- The Department of Health and Human Services and the Department of the Treasury.
Notable Legal, Constitutional, or Political Implications The measure reinforces existing eligibility rules under the Affordable Care Act by using an established data-sharing system (PARIS) to reduce improper payments. It may raise questions about data privacy protections during quarterly comparisons, though it relies on current federal infrastructure rather than creating new data collection authorities.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Recent Actions
- 2025-12-09: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-12-09: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-12-09: Introduced in House
- 2025-12-09: Introduced in House
Bill Versions
- To amend the Patient Protection and Affordable Care Act to identify individuals dually enrolled in Medicaid or CHIP and an Exchange. — issued 2025-12-09 — PDF (3 pages)