CMS and Department of War Re-Establish Data Matching Program for ACA Eligibility Verification

On August 5, 2026, the Centers for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), announced the re-establishment of a crucial data matching program with the Department of War. This program, titled "Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act through a Department of War Health Benefits Plan," serves to ensure the integrity of federal health care subsidies. The notice, published in the Federal Register, signifies a renewed effort to accurately assess eligibility for financial assistance in paying for private health insurance under the Affordable Care Act (ACA).

The Purpose of the Data Match

The core objective of this matching program is to help CMS determine whether individuals applying for or enrolled in private health insurance through federally-facilitated or state-based health insurance exchanges are eligible for financial assistance. Under the ACA, individuals who already have Minimum Essential Coverage (MEC) from another source, such as a Department of War health benefit plan like TRICARE, are generally not eligible for premium tax credits or cost-sharing reductions. These subsidies are designed to make private health insurance more affordable for those who lack other forms of MEC. The matching program provides CMS and state administering entities with the necessary data to prevent erroneous payment of these federal subsidies.

Operational Mechanics and Data Flow

Under the re-established agreement, the Department of War, identified in its system of records as the Department of Defense (DoD), acts as the source agency. It will provide CMS with daily files containing specific data elements for individuals who may be covered by TRICARE. These data elements include Social Security Numbers (SSNs), Coverage Begin Date(s), and Coverage End Date(s). CMS, as the recipient agency, then makes this information available to state administering entities (AEs) through a data services hub. This data is critical for authenticating identity, determining eligibility for financial assistance, and calculating the correct amount of any applicable subsidy.

The categories of individuals whose information is involved are two-fold: those eligible for or enrolled in a TRICARE plan and consumers applying for or enrolled in private insurance coverage through an ACA exchange. The relevant systems of records are CMS's Health Insurance Exchanges System (HIX) and the Department of War's Defense Enrollment Eligibility Reporting System (DEERS).

Adherence to Privacy Act Mandates

This re-established matching program is conducted in strict compliance with the Privacy Act of 1974, as amended. The Privacy Act provides essential safeguards for individuals whose records are subject to computer matching by federal agencies. The notice explicitly states that the program meets the Act's requirements, which include:

• Written Agreement: A formal agreement between CMS and the Department of War, approved by their respective Data Integrity Boards, must be prepared, submitted to Congress and the Office of Management and Budget (OMB), and made publicly available.
• Individual Notification: Individuals whose information is subject to matching must be notified that their data will be verified through this process.
• Verification of Findings: Any match findings must be verified before any adverse action is taken against an individual, such as suspending or terminating benefits.
• Advance Reporting: The program must be reported to Congress and OMB in advance and annually.
• Federal Register Notice: Advance public notice of the matching program must be published in the Federal Register, as has been done with this announcement.

These provisions are designed to protect individual privacy and ensure due process when federal agencies share and match personal data for eligibility determinations. The authority for conducting this program is rooted in 42 U.S.C. 18001, et seq., which encompasses the legislative framework of the Affordable Care Act.

Implications for Individuals and Policy

The re-establishment of this data matching program underscores the federal government's ongoing commitment to responsible stewardship of taxpayer funds and the accurate administration of complex health care laws. For individuals, it means that eligibility for ACA subsidies will continue to be cross-referenced against military health coverage. Those with TRICARE or other Department of War MEC will not be eligible for ACA marketplace subsidies, ensuring that federal support is directed appropriately.

From a policy perspective, this program is a standard mechanism to maintain program integrity across different federal benefit structures. It highlights the intricate connections between various federal agencies and programs in ensuring accurate benefit distribution and preventing fraud or abuse. The continuous verification of MEC is a foundational aspect of the ACA's design, preventing individuals from receiving duplicative federal assistance for health care coverage.

Operational Timeline and Public Input

The re-established matching program is set to commence not sooner than 30 days following the publication of the Federal Register notice, provided no comments are received that necessitate changes. The initial term for this program is 18 months. It may be renewed for up to one additional year if both parties agree there are no changes to the program and certify its compliance with the matching agreement. Interested parties have until September 4, 2026, to submit comments to the CMS Privacy Act Officer. This comment period provides an opportunity for public input and transparency regarding this significant inter-agency data sharing initiative.