After Cutting 760,000 From ACA Plans Over Fraud Claims, CMS Quietly Reinstates Some Enrollees

The Trump administration has reinstated a small number of people it removed from the Affordable Care Act marketplace last month, according to insurance industry sources who spoke to KFF Health News. The Centers for Medicare & Medicaid Services announced in late September that it had cut 760,000 people from the rolls, citing fraud and improper enrollments and touting billions in potential taxpayer savings. More reinstatements could follow in coming weeks if enrollees find out they are uninsured when they try to use their coverage.

CMS selected nearly 1.2 million enrollments for review in June, each showing four warning signs: no Social Security number or immigration document number on the application, a broker involved in the sign-up, no monthly premium payment, and no contact with the insurer or claims filed. The agency sent lists to specific insurers and told them to try at least two methods of contact, such as a phone call and a letter. Enrollees had 30 days to respond and supply missing information. Those who did not were disenrolled.

Supporters say the sweep was overdue. Brian Blase of the Paragon Health Institute, whose findings are often cited by those alleging widespread ACA fraud, defended it. Other policy experts question how many legitimate customers were caught, perhaps because they ignored a letter or missed a call. "It may be true that some of those enrollments were not authorized, but it can be equally true that people got lost in the shuffle and have a valid enrollment," said Katie Keith of Georgetown Law's Center for Health Policy and the Law. "That they are not being very transparent is telling too."

David Merritt of the Blue Cross Blue Shield Association confirmed that some BCBS members have been reinstated and said CMS runs an expedited review for people who learn they were improperly dropped. The administration has not said how robust its outreach was, how long reinstatement takes or how many cancellations have been reversed.

A second phase is already under way. CMS is scrutinizing another 419,000 sign-ups, and insurers must report how many of those enrollees fail to respond "around mid-to-late November, after the midterm elections," Merritt said.

At an Oct. 14 press conference, Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz highlighted the removal this year of subsidies for about 189,000 enrollees who also had Medicare, Medicaid or Children's Health Insurance Program coverage. They cited failures to check for concurrent coverage, and coverage continuing for dead people, rather than fraud, and credited more frequent data matching.

Insurers face real exposure. In a filing with the Securities and Exchange Commission, Oscar Health estimated that 250,000 to 300,000 of its members might be disenrolled. The company had about 3 million members in the second quarter. Overall ACA enrollment has fallen by nearly 3 million in the first months of the year, largely because the enhanced subsidies expired at the end of last year.

The politics are uncertain. Health costs are tied with gas prices as a top concern for voters, and many of those removed are likely in Texas, Florida, Louisiana and Mississippi, where enrollment grew rapidly from 2020 to 2025. The cancellations apply only to states using Healthcare.gov. Harvard's Adrianna McIntyre said the reaction depends on "whether people try to get care and then find out their coverage is no longer active."