The federal marketplace for getting insurance under the Affordable Care Act lacked adequate controls for verifying citizenship status, income and family size to determine eligibility and subsidies, according to a new report.
HHS' Office of Inspector General reviewed 90 applicants from the 2013 and 2014 enrollment periods. The report notes that the problems identified don't necessarily indicate that anyone was improperly enrolled or received subsidies they weren't eligible to receive.
The new report comes weeks after the Government Accountability Office issued a report showing that investigators were able to enroll in health plans, qualify for subsidies and then re-enroll while using false identification information. HHS responded that it does not know of anyone who fraudulently enrolled in coverage.
Acting CMS Administrator Andrew Slavitt agreed with the OIG report's three recommendations in an attached letter.
The recommendations were to improve the marketplace's internal controls, redetermine eligibility of sample applicants and improve procedures for resolving inconsistencies.
“CMS continues to learn from our first year of implementation and from our customers ways to improve both the customer experience and the efficiency of our operations,” Slavitt wrote in the letter.
To be eligible to enroll in a qualified health plan, a person must be a U.S. citizen, a U.S. national or be lawfully in the U.S. People who are incarcerated are not eligible.
To qualify for a subsidy, the applicant must make below a certain income level but also not be eligible for minimum essential coverage through an employer plan or government program such as Medicaid or Medicare.
