By skyforbes 
Medicaid fraud and duplicate enrollment siphon precious dollars from patient care. Recent investigative reporting found that taxpayers spent nearly $4.3 billion covering many of the same beneficiaries twice in just three years, primarily because individuals who relocated did not surrender their original Medicaid enrollment. Private insurers kept the surplus premiums while public budgets absorbed the loss. These figures reflect a broader pattern that the Government Accountability Office has been documenting for years. A report released this spring identified tens of thousands of capitation payments made on behalf of beneficiaries who held more than one Medicaid identification number in a single state, resulting in at least $14.5 million in unrecovered overpayments — the same report flags concurrent enrollment across state lines as an even bigger vulnerability.
Chapter 1 of the new One Big Beautiful Bill tackles that vulnerability head-on. Section 71103 instructs the Centers for Medicare & Medicaid Services (CMS) to build a single nationwide verification hub. By 2027, every state must feed the hub with authoritative address data pulled from sources such as the U.S. Postal Service, state licensing boards, and federal change-of-address files. By the 2030 fiscal year, states must also transmit Social Security numbers for every Medicaid and Children’s Health Insurance Program enrollee at least once a month. In return, CMS will issue a monthly roster of individuals who appear on more than one state’s rolls so each state can act before the next capitation invoice arrives. Congress has already appropriated start-up funds for 2026 and earmarked ongoing maintenance dollars for 2029.
Why does this matter to health-care leaders? First, duplicate coverage drives plan expenditures that never reach clinical services. When payments flow to the wrong plan or two plans simultaneously, health systems still carry the clinical load while funding evaporates. Second, duplicate files complicate quality reporting and risk adjustment. Star ratings, supplemental payments, and even value-based bonuses rely on accurate denominator counts. Every ghost record skews those metrics and threatens reimbursement downstream. Finally, improper enrollment erodes public trust at a moment when state agencies need political capital to defend Medicaid’s scope. The new CMS hub promises stronger guardrails, yet it will also press organizations to modernize data stewardship. Eligibility files in many states still reside on platforms coded before the millennium. Integrating with the federal hub will require migration to modern application programming interfaces, encryption protocols, and deterministic matching algorithms. Health-care executives should ask their Medicaid directors three questions now:
- Data quality readiness. How complete are the address and Social Security fields today? Missing or stale data will create false positives once the hub launches.
- Workflow alignment. Who will review the monthly duplicate roster, and how quickly can the team verify status, notify affected members, and adjust capitation feeds?
- Provider communication. Will clinics and hospitals receive real-time notifications when a patient’s eligibility status changes, allowing scheduling and billing teams to respond promptly without delaying care?
Early preparation is worth the effort. Some states that proactively cross-checked residency data with the Supplemental Nutrition Assistance Program (SNAP) or national death records have already reduced duplicate enrollment rates to near one percent. Those pilots demonstrated measurable savings within the first fiscal year and enhanced the accuracy of Medicaid managed-care encounter data, which informs quality dashboards and federal reports.
Hospitals and physician groups can contribute in practical ways. Encourage patients to update their address at every registration point and embed that prompt in electronic check-in kiosks. Strengthen collaboration with managed-care plans to reconcile member rosters on a monthly basis. Use health information exchanges to verify that newly referred patients carry active coverage in the current state before ordering high-cost services. Each of these steps complements the federal hub and reduces the likelihood that legitimate beneficiaries will lose coverage due to clerical errors.
Still, leaders must anticipate operational tension. States that aggressively purge duplicate files may also trigger legitimate coverage terminations if algorithms misclassify college students, migrant workers, or unhoused individuals who frequently change locations. Outreach teams should craft clear messages: coverage continues as long as residency is current and documentation stays up to date. Leverage community health workers and digital portals to make the update process intuitive.
Looking beyond fraud prevention, the centralized approach can unlock analytical dividends. With reliable, non-duplicative identifiers, researchers can now generate multi-state panels that follow Medicaid beneficiaries through life events such as childbirth, job loss, or chronic disease progression. This longitudinal lens will enrich policy debates about social drivers of health in ways that fragmented data never could.
Section 71103 does not solve every Medicaid integrity problem, yet it sends a clear signal: the era of accepting fragmented eligibility data is coming to a close. Healthcare leaders who move past a compliance mindset and seize the opportunity to clean their data will reap financial and clinical benefits long before statutory deadlines arrive. Start the conversation with your Medicaid counterparts today, assign an executive sponsor, and set measurable milestones. When the CMS hub lights up in 2027, organizations that did the groundwork will spend less energy on crisis response and more on patient outcomes — the true north of any mission in care delivery.