Managers of the new public health insurance exchanges had trouble resolving applicant information conflicts, or even counting the conflicts. Officials at the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) come to that conclusion in a review of applicant data inconsistencies at the new Patient Protection and Affordable Care Act (PPACA) exchanges.
Investigators looked into the matter to see how exchanges were handling obvious, basic problems with consumers’ “qualified health plan” (QHP) applications from October — when the first individual QHP open enrollment period began — until December 2013. States and the District of Columbia ran 15 exchanges, and the U.S. Department of Health and Human Services (HHS) ran the other 36 exchanges.
The exchanges were supposed to use information from a variety of sources, including tax information and credit history information available through a federal data hub, to verify the information on consumers’ applications. The exchanges were checking to see whether the consumers were eligible to buy QHP coverage, and whether the consumers were eligible for help with paying for the coverage.
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During the period reviewed, the HHS exchanges had counted 2.9 million inconsistencies and resolved 300,000, investigators say. Four states with state-based exchanges — Colorado, Minnesota, Nevada and Oregon — had no data on inconsistencies.
Massachusetts, Nevada, Oregon and Vermont said they were too busy dealing with computer problems to resolve inconsistencies during the study period. The managers of the California and Colorado exchanges said they got off to late starts with resolving inconsistencies because of changes they made in their procedures for handling inconsistencies.
Managers in seven jurisdictions — Connecticut, the District of Columbia, Maryland, New York, Rhode Island and Washington state — said their processes for resolving inconsistencies worked smoothly.
Marilyn Tavenner, the administrator of the Centers for Medicare & Medicaid Services (CMS) — the HHS agency in charge of the HHS-run exchange program — said the inconsistency numbers look bad partly because the HHS OIG investigators reviewed a period when enrollment was still under way, and program rules gave the exchanges more time to resolve any problems.
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HHS now has automated systems in place to resolve most of the QHP application inconsistencies, and it’s finding that, when it does check applications, the applicants usually turn out to be eligible for the coverage and financial support received, Tavenner writes in a memo to HHS OIG officials.
In addition to finding that some exchange managers had trouble counting and resolving data conflicts, the HHS OIG investigators found that inconsistency count patterns vary widely from exchange to exchange.
In California, for example, exchange managers found an income data conflict in about one-sixth of the QHP applications and a Social Security number problem in only about 0.14 percent of the applications. They reported 686 conflicts with QHP application income information for every Social Security number problem found.
Exchange managers in Hawaii found income problems in only about 4 percent of their QHP applications and Social Security number problems in 1.4 percent of the applications. They counted just three income data conflicts per Social Security number conflict.
In Kentucky, 29 percent of the applications had income data problems and 3.3 percent had Social Security number problems. That state had about 9 income data problems per Social Security number problem.