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July 16, 2014 at 07:07 AM
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 HealthCare.gov, 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.
