Feds Swap Health Data to Hunt ACA Coverage Cheats
Published Date: 7/29/2026
Notice
Summary
In accordance with the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of the re-establishment of a matching program between CMS and the Office of Personnel Management, "Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act through an Office of Personnel Management Health Benefit Plan". The matching program provides CMS and State Administering Entities with the Office of Personnel Management (OPM) data to use in determining individuals' eligibility to enroll in a qualified health plan through an exchange established under the ACA; for insurance affordability programs, certifications of exemption, and to make eligibility redeterminations and renewals, including appeal determinations.
Analyzed Economic Effects
3 provisions identified: 0 benefits, 1 costs, 2 mixed.
OPM Data Used to Verify Marketplace Eligibility
CMS and State Administering Entities will use data from the Office of Personnel Management (OPM) to determine whether you can enroll in a qualified health plan through an Exchange, qualify for insurance affordability programs, get certifications of exemption, and for eligibility redeterminations, renewals, and appeals. This matching program becomes effective 30 days after the July 29, 2026 Federal Register notice (effective August 28, 2026) and runs for an initial 18-month term.
Annual Premium Spread Data Used for Eligibility
OPM will send CMS an annual Premium Spread Index File that identifies the lowest premium available to a Federal employee in each of 32 premium localities. CMS will use OPM data (including this premium information) in making determinations for insurance affordability programs, certifications of exemption, and Exchange enrollments starting August 28, 2026.
Monthly Sharing of Federal Employee Records
OPM will send CMS a monthly, fully refreshed Status File listing active Federal employees with data elements including Social Security Number, full name, sex, date of birth, unique person ID, and Health Plan Code. The monthly transfer of these personal identifiers to CMS and State Administering Entities is part of the matching program that starts August 28, 2026.
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Key Dates
Department and Agencies
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