Who is affected and how:

• Medicaid and CHIP beneficiaries: Most directly affected when matches signal death; legitimate deceased beneficiaries will be removed from rolls, while beneficiaries who are mistakenly matched to death records face temporary disenrollment until errors are corrected and coverage is restored retroactively.

• State Medicaid agencies and program administrators: Bear primary responsibility for implementing quarterly matching, updating enrollment systems, stopping payments, processing appeals and reinstatements, and ensuring compliance with federal Medicaid rules; this will create new ongoing operational and IT tasks.

• Medicaid managed care organizations and health-care providers: Could see payments stopped if a beneficiary is removed; providers may face delays in reimbursement until discrepancies are resolved or coverage is reinstated retroactively.

• Centers for Medicare & Medicaid Services (CMS) and federal oversight: Will oversee compliance and may provide guidance or audits; federal program integrity goals (reducing improper payments) are advanced.

• Taxpayers and budgets: Potential reduction in improper payments to deceased individuals may produce savings; conversely, states may incur implementation costs (system upgrades, staff time) that could be unfunded unless separate funding is provided.

Operational risks and tradeoffs:

• Administrative burden: States will need resources to run matches, reconcile results, adjudicate cause-of-death mismatches, and process retroactive restorations.
• Error/harms: False matches can cause wrongful disenrollment and interruption of care; the law requires prompt restoration but temporary gaps can still harm individuals.
• Privacy/data use: Increased automated matching raises data-handling and privacy considerations; states must protect sensitive information while using electronic sources.

Overall effect: Improves enrollment accuracy and program integrity but shifts implementation and operational costs and responsibilities to States and may require careful operational safeguards to prevent or quickly fix wrongful disenrollments.