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Watchdogs: 'Good' state-based exchanges also have controls problems

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Federal investigators say they found weaknesses in applicant eligibility review systems at the state-based public exchanges in California and Connecticut.

During a review period that ran from October 2013 through December 2013, the Covered California and Access Health CT exchanges did not keep all of the eligibility data they needed to show that applicants were eligible to enroll in exchange programs, according to Kay Daly and Joyce Greenleaf, officials at the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG).

The Patient Protection and Affordable Care Act (PPACA) provides two sets of subsidies for QHP applicants: Premium subsidies, and “cost-sharing reduction” subsidies that help lower-income enrollees pay QHP deductibles, co-payments and coinsurance amounts.

Staff members from HHS OIG — an agency that monitors the U.S. Department of Health and Human Services (HHS) — went to the offices of the California and Connecticut exchanges to see how well those exchanges were verifying the information provided by people who wanted to sign up for private qualified health plan (QHP) coverage and QHP subsidies through the exchange.

HHS OIG staffers also visited the offices of, the enrollment system for the HHS-run PPACA public exchanges.

California and Connecticut had enrollment websites that worked reasonably smoothly during the first public exchange individual QHP open enrollment period, which ran in most of the country from Oct. 1, 2013, through mid-April 2014. Managers of exchanges in other states have viewed Access Health CT, in particular, as an example of a state with a successful state-based public exchange.

“The presence of an internal control deficiency does not necessarily mean that a marketplace improperly enrolled an applicant in a [qualified health plan] or improperly determined eligibility for insurance affordability programs,” Daly and Greenleaf say in a written version of testimony for a U.S. House Energy & Commerce health subcommittee hearing on PPPACA exchange eligibility verification programsBut the internal controls problems could limit the exchanges’ ability to prevent the use of inaccurate information in QHP eligibility applications, the officials say.

In a full HHS OIG report released early, agency officials reported that both Covered California and Access Health CT had good controls in place for verifying whether applicants were incarcerated.

Covered California seemed to have trouble with controls for verifying applicants’ information about citizenship and lawful presence in the country. Access Health CT had problems with controls for verifying whether consumers had minimum essential coverage through non-employer-sponsored insurance.

Neither exchange always maintained eligibility data properly, investigators found.

See also: Exchange plan users face calls about ‘inconsistencies’


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