Privacy Act of 1974; Matching Program

Issuing agencies

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 a computer matching program between CMS and participating State-Based Administering Entities (AEs), titled "Determining Eligibility for Enrollment in Applicable State Health Subsidy Programs Under the Patient Protection and Affordable Care Act". The matching program supports eligibility determinations for enrollment in applicable State health subsidy programs under the Patient Protection and Affordable Care Act (PPACA), including Qualified Health Plans (QHPs), Medicaid, the Children's Health Insurance Program (CHIP), and Basic Health Programs (BHPs). The matching program also supports implementation of statutory requirements concerning Medicaid community engagement and the prevention of concurrent Medicaid enrollment in more than one State through the Multi-State Enrollment Prevention (MSEP) system.

Full Text

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<title>Federal Register, Volume 91 Issue 208 (Thursday, October 29, 2026)</title>
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[Federal Register Volume 91, Number 208 (Thursday, October 29, 2026)]
[Notices]
[Pages 68151-68153]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-22015]


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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 (CMS), The Department 
of Health and Human Services (HHS).

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 
a computer matching program between CMS and participating State-Based 
Administering Entities (AEs), titled ``Determining Eligibility for 
Enrollment in Applicable

[[Page 68152]]

State Health Subsidy Programs Under the Patient Protection and 
Affordable Care Act''. The matching program supports eligibility 
determinations for enrollment in applicable State health subsidy 
programs under the Patient Protection and Affordable Care Act (PPACA), 
including Qualified Health Plans (QHPs), Medicaid, the Children's 
Health Insurance Program (CHIP), and Basic Health Programs (BHPs). The 
matching program also supports implementation of statutory requirements 
concerning Medicaid community engagement and the prevention of 
concurrent Medicaid enrollment in more than one State through the 
Multi-State Enrollment Prevention (MSEP) system.

DATES: The deadline for comments on this notice is November 30, 2026. 
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, by mail or email, to the CMS Privacy Officer, Division of 
Security, Privacy Policy & Oversight, Information Security & Privacy 
Group, Office of Information Technology, Centers for Medicare & 
Medicaid Services, Location: N1-14-56, 7500 Security Blvd., Baltimore, 
MD 21244-1850, to <a href="/cdn-cgi/l/email-protection#0e6c6f7c6c6f7c6f206a6b63617e7b62617d4e6d637d2066667d20696178"><span class="__cf_email__" data-cfemail="ddbfbcafbfbcafbcf3b9b8b0b2ada8b1b2ae9dbeb0aef3b5b5aef3bab2ab">[email&#160;protected]</span></a>.

FOR FURTHER INFORMATION CONTACT: If you have questions about the 
matching program, you may contact Terence Kane, Director, Division of 
Automated Verifications and SEP Policy, Marketplace Eligibility and 
Enrollment Group, Center for Consumer Information & Insurance 
Oversight, Centers for Medicare & Medicaid Services, CMS, at (410) 218-
6687 or by email: <a href="/cdn-cgi/l/email-protection#ffab9a8d9a919c9ad1b49e919abf9c928cd197978cd1989089"><span class="__cf_email__" data-cfemail="9cc8f9eef9f2fff9b2d7fdf2f9dcfff1efb2f4f4efb2fbf3ea">[email&#160;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 satisfies these requirements. It re-
establishes the matching that has been in place since 2013 and was most 
recently re-established in 2025, as described in 90 FR 51764.

Barbara Demopulos,
CMS 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.
    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.

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 (1) applicants, meaning individuals who apply for 
eligibility to enroll in applicable state health subsidy programs 
through an Exchange established under the PPACA or through a state 
Medicaid, CHIP, or BHP agency; (2) enrollees, meaning individuals 
currently enrolled in those programs whose eligibility is being 
redetermined, renewed, or periodically verified, including verification 
of Medicaid community engagement and of concurrent Medicaid enrollment 
in more than one state; and (3) non-applicant members of the 
applicant's household who are listed on the application by name and 
date of birth or SSN and whose information bears on the applicant's 
eligibility, such as the tax filer, the tax filer's spouse, tax 
dependents, and other household members whose income is counted in 
determining household income.

[[Page 68153]]

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; postsecondary educational enrollment 
records 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, and, from state Medicaid and CHIP agencies, Medicaid and CHIP 
eligibility and enrollment information (such as program type, 
eligibility dates, state, and state beneficiary identifier).
    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), Veteran's 
disability rating data; educational enrollment data; Social Security 
Title II benefits (retirement, survivors, and disability insurance) and 
current income sources; Quarters of Coverage; and Death Indicator.

System(s) of Records

    The records used in this matching program will be disclosed from 
the following systems of records, consistent with the routine uses 
identified in the applicable System of Records Notices (SORNs):
    CMS Health Insurance Exchanges System (HIX), CMS System No. 09-70-
0560, last published in full at 78 FR 63211 (October 23, 2013), as 
amended at 83 FR 6591 (February 14, 2018).

[FR Doc. 2026-22015 Filed 10-28-26; 8:45 am]
BILLING CODE 4120-03-P


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