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March 11, 2016 at 10:37 AM
The public health insurance exchange in Vermont had trouble with many types of applicant eligibility verification steps in 2014, and it had no regular system for telling applicants about the application problems it did find, a federal watchdog agency says.
Officials at the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) talk about the Vermont Health Connect eligibility verification process in a new report.
See also: Vermont CO-OP still in limbo
Vermont used cash from the U.S. Department of Health and Human Services (HHS) to start Vermont Health Connect, a Patient Protection and Affordable Care Act (PPACA) exchange. HHS OIG, an agency that keeps tabs on HHS, has been auditing eligibility controls at all of the PPACA exchanges.
To get PPACA premium tax credit subsidies for PPACA exchange qualified health plan (QHP) coverage, consumers must show that they are in the country legally and are out of incarceration. They also need to show that they meet income eligibility requirements, and that they lack access to some other type of public or private major medical coverage.
HHS OIG auditors have been looking at random samples of applicant files at each exchange to see whether an exchange generally used outside information to verify what the applicants said; whether the exchange was consistent about seeking the outside information; and how the exchange handled apparent inconsistencies between what an applicant said and information from outside sources.
See also: Agency finds holes in an exchange program’s eligibility screening
For Vermont Health Connect, HHS OIG auditors looked at a random sample of 45 application files from a pool of 24,865 individual coverage application files opened from Oct. 1, 2013 through March 31, 2014.
