A report from the Paragon Health Institute estimates that 47% of all Affordable Care Act (ACA) enrollment in Mississippi during the 2026 open enrollment period was improper. The study highlights issues related to enrollment integrity and potential fraud, particularly on the federal HealthCare.gov platform used by the state, according to Liam Sigaud, an author of the report.
Sigaud, an adjunct scholar with Paragon and a research associate at West Virginia University, explained that improper enrollments often involve individuals being signed up without their knowledge or consent. He noted that some cases result from unscrupulous brokers and enrollment intermediaries collecting personal information under false pretenses and enrolling people fraudulently.
The report states that Mississippi had 313,392 total exchange sign-ups in 2026, with about 79% claiming income within the 100% to 150% federal poverty level. However, Sigaud said the income distribution was implausible and that only about 98,935 enrollees were likely eligible for subsidies. The report attributes widespread improper enrollments to weak identity verification, easy broker access, and permissive special enrollment periods, which can incentivize fraud.
Sigaud cited a federal case in Florida involving a brokerage accused of enrolling thousands of vulnerable consumers into subsidized plans fraudulently, resulting in the federal government paying $141.5 million in unwarranted subsidies. He added that some fraud networks target homeless shelters and soup kitchens, offering cash or gifts to obtain personal information for illegal enrollment.
Mississippi’s reliance on the federal exchange limits its ability to control enrollment processes. State lawmakers have attempted to establish a state-based exchange, but efforts have repeatedly stalled. Despite legislation in 2024 authorizing the creation of a Mississippi exchange, the state’s insurance commissioner and governor have not moved forward.
Sigaud suggested that Mississippi could improve oversight by engaging its congressional delegation to advocate for stricter federal rules and increasing scrutiny of brokers and agencies. He also noted that states with their own exchanges tend to have lower rates of improper enrollment due to stronger verification and oversight, which could be a model for Mississippi.
Nationally, the report estimates that about 6.2 million ACA enrollees in 2026 are improperly signed up, with the federal government potentially paying up to $25 billion in unwarranted subsidies. Sigaud projected that Mississippi’s improper enrollments could cost taxpayers more than $600 million.
The full report, titled “The Persistent Obamacare Enrollment Fraud,” is available from the Paragon Health Institute.
Jon Ross Myers is the executive editor and publisher of the Mississippi News Network, Mississippi's largest digital only media company. He can be reached at editor@tippahnews.com
