The CMS wants to ease enrollment on the federal insurance marketplace and keep it affordable by expediting the application process and signing up people who are rejected for Medicaid.
The agency said last week that it wants to expedite household income verification for consumers applying for marketplace coverage. The change would reduce the number of consumers who must submit follow-up documentation to verify their income, the agency says in a July 22 notice (PDF).
For most consumers, the CMS can verify household income immediately; however, there are times the agency's go-to sources, such as the IRS, Social Security and credit reporting services, don't have the data.
In such instances, the CMS requests more information, and if consumers do not respond quickly, their subsidies or tax credits are decreased or ended.
The CMS defines an income discrepancy as being more than 10% less than what's reported by other data sources. The agency is now changing that threshold to be more than 25% less.
In June, the agency revealed that 73,000 households with discrepancy issues had their subsidies or tax credits adjusted or ended. That was down from 734,000 households from the prior year.
“Data-matching terminations are down significantly from last year," said Tim Jost, a law professor at Washington and Lee University, adding that the recent policy change should help further.
On Monday, the CMS released a second notice (PDF) targeting consumers who make too much for Medicaid but may be eligible for marketplace coverage.
According to the new policy, states should treat anyone determined ineligible for Medicaid and CHIP as potentially eligible for marketplace enrollment. The state would electronically transfer that person's information to the federal marketplace. The CMS did not release estimates on how many people this may impact.
“This simplifies the assessment required under the regulations and ensures that consumers have the ability to purchase a qualified health plan," the agency said in the notice.
