Agency finds holes in an exchange program's eligibility screening

During the first open enrollment period, the Colorado exchange skipped incarceration, state residence and lawful presence checks for consumers who did not apply for tax credits.

“Contrary to federal requirements, the Colorado marketplace enrolled these applicants in a [qualified health plan] without obtaining the required verification,” HHS OIG officials say. 

For the 31 applicants who did apply for premium tax credits, the exchange failed to check whether the applicants were federal employees, who were eligible for federal employee health benefits, officials say.

Twenty-five of the applicants who applied for tax credits had conflicts between application information and information from other sources, such as government income data. The exchange resolved 19 of those inconsistencies, but it seems to have failed to resolve six of the inconsistencies, officials say.

In a letter to Patrick Cogley, an HHS OIG regional inspector general in Kansas City, Mo., Alan Schmitz, the Colorado exchange general counsel, said the exchange is looking into options for verifying the information submitted by applicants who did not seek premium tax credits.

Those customers do attest that the information they are providing is accurate, Schmitz wrote in the letter.

Customers also attest that they are not eligible for MEC from the federal employees’ health benefits program, but the Colorado exchange is looking at options for verifying applicants’ attestations about lack of access to MEC, Schmitz said.

The Colorado exchange has improved its inconsistency verification and resolution process since HHS OIG officials conducted their audit, and it now has an automated process for removing tax credit eligibility for consumers who fail to provide the documents needed to clear up inconsistencies, Schmitz said.

See also:

3 things you CAN’T know about IRS PPACA problems

4 holes in PPACA exchange data security safeguards

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