Bill Summary
This legislation proposes an amendment to the Patient Protection and Affordable Care Act (PPACA) aimed at improving the identification of individuals who are dually enrolled in Medicaid or the Children's Health Insurance Program (CHIP) and a health plan offered through an Exchange.
The key provisions include:
1. **Establishment of a Program**: The Secretary of Health and Human Services is required to create a program that will regularly (at least quarterly) compare enrollment information from qualified health plans in the Exchanges with data from state Medicaid and CHIP programs. This comparison will utilize the Public Assistance Reporting Information System (PARIS) or a similar system.
2. **Identification of Dual Enrollments**: The goal of the program is to identify individuals who are receiving benefits from both a qualified health plan and a Medicaid or CHIP plan, thereby ensuring that those individuals are not improperly receiving premium tax credits or cost-sharing reductions intended for those who are not enrolled in other forms of assistance.
3. **Enforcement Measures**: The Secretary will be responsible for taking appropriate actions to notify Exchanges and the Treasury Department about individuals identified under this program, ensuring compliance and preventing overlapping benefits.
Overall, this amendment seeks to enhance the integrity of the health care assistance programs by preventing individuals from receiving financial support for health coverage when they are already covered through Medicaid or CHIP.
Possible Impacts
The legislation described in the bill has implications for individuals who are dually enrolled in Medicaid or the Children's Health Insurance Program (CHIP) and a health plan through an Exchange. Here are three examples of how this could affect people:
1. **Reduction of Financial Aid for Dually Enrolled Individuals**:
The identification of individuals who are dually enrolled means that those found to be receiving both Medicaid/CHIP benefits and premium tax credits or cost-sharing reductions through an Exchange may lose their financial assistance. This could lead to increased out-of-pocket costs for medical services for those individuals, as they may no longer qualify for subsidies that help reduce the cost of their health insurance.
2. **Increased Administrative Oversight**:
The requirement for the Secretary to establish a program for identifying dually enrolled individuals could lead to improved data sharing and oversight. While this may streamline processes and reduce instances of overlapping coverage, it could also create additional administrative burdens for individuals who may need to provide documentation or clarification regarding their eligibility, which can cause confusion and stress.
3. **Impact on Access to Healthcare**:
For individuals who rely on both Medicaid/CHIP and Exchange plans for comprehensive coverage, the potential loss of premium tax credits or cost-sharing reductions could result in reduced access to necessary healthcare services. Individuals may find it financially challenging to maintain their current level of care, leading to potential delays in treatment or avoidance of necessary medical services due to cost concerns. This could adversely affect their overall health and well-being.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6516 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 6516
To amend the Patient Protection and Affordable Care Act to identify
individuals dually enrolled in Medicaid or CHIP and an Exchange.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 9, 2025
Mr. Burchett introduced the following bill; which was 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
_______________________________________________________________________
A BILL
To amend the Patient Protection and Affordable Care Act to identify
individuals dually enrolled in Medicaid or CHIP and an Exchange.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. IDENTIFICATION OF DUAL MEDICAID OR CHIP AND EXCHANGE
ENROLLMENTS.
Section 1311(c) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18031(c)) is amended by adding at the end the following new
paragraph:
``(8) Identification of dual medicaid and exchange
enrollments.--
``(A) In general.--The Secretary shall, not later
than 60 days after the date of the enactment of this
paragraph, establish a program under which, on a
recurring basis, but not less frequently than
quarterly, the information of each individual enrolled
in a qualified health plan through an Exchange is
compared through the Public Assistance Reporting
Information System (PARIS) facilitated by the Secretary
(or any successor system) with the information of each
individual enrolled in a State plan (or waiver of such
plan) under title XIX of the Social Security Act, or a
State child health plan under title XXI of such Act (or
a waiver of such plan), for purposes of identifying
individuals enrolled in both such a qualified health
plan and such a State plan (or waiver) or State child
health plan (or waiver).
``(B) Enforcement.--The Secretary shall take such
actions as the Secretary determines appropriate (such
as the notification of applicable Exchanges and the
Secretary of the Treasury) to ensure that no individual
identified under the program established under
subparagraph (A) is receiving premium tax credits under
section 36B of the Internal Revenue Code of 1986 or
cost sharing reductions under section 1402.''.
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