In theory, a prison inmate in Kansas who was in the country illegally might have been able to get public exchange plan coverage in Colorado during the first open enrollment period, as long as the inmate did not apply for premium tax credit subsidies.
Officials at the Health and Human Services Office of Inspector General (HHS OIG) have published findings raising that possibility in a report on an audit of the exchange plan eligibility determination process at Connect for Health Colorado.
The Patient Protection and Affordable Care Act (PPACA) set up the exchange system, and it also created a premium subsidy tax credit.
Adult consumers can use a state’s exchange only if they are not incarcerated, are in the country legally, and meet state residency requirements, HHS OIG officials say.
To qualify for the premium tax credit subsidy, consumers must meet income requirements and show they are not eligible for affordable minimum essential coverage (MEC) from an employer.
Auditors from HHS OIG, an agency that oversees the U.S. Department of Health and Human Services (HHS), visited the offices of the Colorado exchange in the summer of 2014 to see how the exchange had handled the eligibility determinations during the first open enrollment period.
The auditors reviewed a random sample of files for 45 of the 37,964 people who enrolled in Connect for Health Colorado plans from Feb. 22, 2014, through March 31, 2014.
The auditors looked only at internal controls and procedures and not whether the exchange had made any incorrect determinations.
The auditors found that 14 of the sample applicants had not asked for premium tax credit subsidies.