Notice2025-20058
Privacy Act of 1974; Matching Program
Primary source
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Published
November 18, 2025
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
In accordance with subsection (e)(12) of 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 State-Based Administering Entities (AEs), titled "Determining Eligibility for Enrollment in Applicable State Health Subsidy Programs Under the Patient Protection and Affordable Care Act."
Full Text
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<title>Federal Register, Volume 90 Issue 220 (Tuesday, November 18, 2025)</title>
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[Federal Register Volume 90, Number 220 (Tuesday, November 18, 2025)]
[Notices]
[Pages 51764-51765]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-20058]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Matching Program
AGENCY: Centers for Medicare & Medicaid Services, Department of Health
and Human Services.
ACTION: Notice of a new matching program.
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SUMMARY: In accordance with subsection (e)(12) of 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 State-Based
Administering Entities (AEs), titled ``Determining Eligibility for
Enrollment in Applicable State Health Subsidy Programs Under the
Patient Protection and Affordable Care Act.''
DATES: The deadline for comments on this notice is December 18, 2025.
The re-established matching program will commence not sooner than 30
days after publication of this notice, provided no comments are
received that warrant a change to this notice. The matching program
will be conducted for an initial term of 18 months (from approximately
October 2025 to March 2027) and, within three months of expiration, may
be renewed for up to one additional year if the parties make no changes
to the matching program and certify that the program has been conducted
in compliance with the matching agreement.
ADDRESSES: Interested parties may submit written comments on this
notice to the CMS Privacy Act Officer by mail at: Division of Security,
Privacy Policy & Governance, Information Security & Privacy Group,
Office of Information Technology, Centers for Medicare & Medicaid
Services, Location: N1-14-56, 7500 Security Blvd., Baltimore, MD 21244-
1850, or by email at <a href="/cdn-cgi/l/email-protection#8cceedfeeeedfeeda2c8e9e1e3fcf9e0e3ffccefe1ffa2e4e4ffa2ebe3fa"><span class="__cf_email__" data-cfemail="14567566767566753a5071797b6461787b67547779673a7c7c673a737b62">[email protected]</span></a>.
FOR FURTHER INFORMATION CONTACT: If you have questions about the
matching program, you may contact: Robert Yates, Deputy Director,
Division of State and Grant Operations, State Marketplace and Insurance
Programs Group, Center for Consumer Information and Insurance
Oversight, Centers for Medicare & Medicaid Services, 7500 Security
Blvd., Baltimore, MD 21224, or by email to <a href="/cdn-cgi/l/email-protection#6b3904090e191f45320a1f0e182b08061845030318450c041d"><span class="__cf_email__" data-cfemail="8ddfe2efe8fff9a3d4ecf9e8fecdeee0fea3e5e5fea3eae2fb">[email protected]</span></a>, or
Jenny Chen, Director, Division of State Technical Assistance, State
Marketplace and Insurance Programs Group, Center for Consumer
Information and Insurance Oversight, Centers for Medicare & Medicaid
Services, 7501 Wisconsin Ave., Bethesda, MD 20814, or by email to
<a href="/cdn-cgi/l/email-protection#aae0cfc4c4d384e9c2cfc4eac9c7d984c2c2d984cdc5dc"><span class="__cf_email__" data-cfemail="bef4dbd0d0c790fdd6dbd0feddd3cd90d6d6cd90d9d1c8">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: The Privacy Act of 1974, as amended (5
U.S.C. 552a) provides certain protections for individuals applying for
and receiving federal benefits under federal benefit programs. The law
governs the use of computer matching by federal agencies when records
in a system of records (meaning, federal agency records about
individuals retrieved by name or other personal identifier) are matched
with records of other federal or non-federal agencies. The Privacy Act
requires agencies involved in a matching program to:
1. Enter into a written agreement, which must be prepared in
accordance with the Privacy Act, approved by the Data Integrity Board
of each source and recipient federal agency, provided to Congress and
the Office of Management and Budget (OMB), and made available to the
public, as required by 5 U.S.C. 552a(o), (u)(3)(A), and (u)(4).
2. Notify the individuals whose information will be used in the
matching program that the information they provide is subject to
verification through matching, as required by 5 U.S.C. 552a(o)(1)(D).
3. Verify match findings before suspending, terminating, reducing,
or making a final denial of an individual's benefits or payments or
taking other adverse action against the individual, as required by 5
U.S.C. 552a(p).
4. Report the matching program to Congress and the Office of
Management and Budget (OMB), in advance and annually, as required by 5
U.S.C. 552a(o)(2)(A)(i), (r), and (u)(3)(D).
5. Publish advance notice of the matching program in the Federal
Register as required by 5 U.S.C. 552a(e)(12).
This matching program meets these requirements.
Barbara Demopulos,
Privacy Act Officer, Division of Security, Privacy Policy and
Governance, Office of Information Technology, Centers for Medicare &
Medicaid Services.
PARTICIPATING AGENCIES:
The agencies participating in the matching program are the
Department of Health and Human Services (HHS), Centers for Medicare &
Medicaid Services (CMS), and State-Based Administering Entities (AEs).
Currently, each of the 50 states, the District of Columbia, and Puerto
Rico has one or more AE(s) participating in this matching program.
Other U.S. territories may eventually participate. Each party (CMS and
each participating AE) is a source agency, and each AE is a recipient
agency, in this matching program, as explained in the Purpose(s)
section below.
AEs administer insurance affordability programs, and include
Medicaid/Children's Health Insurance Program (CHIP) agencies, state-
based exchanges (SBEs), and basic health programs (BHPs). In states
that operate a SBE, the AE would include the Medicaid/CHIP agency.
Additionally, there are two states--Minnesota and New York--where the
AE operates as both a SBE and BHP. In states that have elected to
utilize the federally-facilitated exchange (FFE), the AE would include
only the Medicaid/CHIP agency.
AUTHORITY FOR CONDUCTING THE MATCHING PROGRAM:
The principal authority for conducting the matching program is 42
U.S.C. 18001, et seq.
[[Page 51765]]
PURPOSE(S):
The matching program will enable CMS to provide information
(including information CMS receives from other federal agencies under
related matching agreements) to AEs, to assist AEs in verifying
applicant information as required by the Patient Protection and
Affordable Care Act of 2010 (PPACA) to determine applicants'
eligibility for enrollment in applicable state health subsidy programs,
including exemption from the requirement to maintain minimum essential
coverage (MEC) or from the individual responsibility payment. In
addition, to avoid dual enrollment, information will be shared between
CMS and AEs, and among AEs, for the purpose of verifying whether
applicants and enrollees are currently eligible for or enrolled in a
Medicaid/CHIP program. All information will be shared through a data
services hub (Hub) established by CMS to support the federally-
facilitated health insurance exchange (which CMS operates) and state-
based exchanges.
CATEGORIES OF INDIVIDUALS:
The individuals whose information will be used in the matching
program are consumers who apply for eligibility to enroll in applicable
state health insurance subsidy programs through an exchange established
under the PPACA and other relevant individuals (such as, applicants'
household members).
CATEGORIES OF RECORDS:
The categories of records that will be used in the matching program
are identifying records; minimum essential coverage period records;
return information (household income and family size information);
citizenship status records; birth and death information; disability
coverage and income information; and imprisonment status records.
The data elements CMS will receive from AEs may include: Social
Security Number (if applicable), Last Name, First Name, and Date of
Birth.
The data elements the AEs will receive from CMS may include:
Validation of SSN; Verification of citizenship or immigration status;
Incarceration status; Eligibility and/or enrollment in certain types of
MEC; Income, based on Federal Tax Information (FTI), Title II benefits,
and current income sources; Quarters of Coverage; and Death Indicator.
SYSTEM(S) OF RECORDS:
The records that CMS will disclose to AEs will be disclosed from
the following system of records, as authorized by routine uses 2 and 3
published in the System of Records Notice (SORN) cited below:
CMS Health Insurance Exchanges System (HIX), CMS System No. 09-70-
0560, last published in full at 78 FR 63211 (Oct. 23, 2013), as amended
at 83 FR 6591 (Feb. 14, 2018).
[FR Doc. 2025-20058 Filed 11-17-25; 8:45 am]
BILLING CODE 4120-03-P
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