The Affordable Care Act created a new eligibility system for affordable health insurance, relying primarily on electronic data sources rather than paper and pay stubs to evaluate applications. During the first historic open enrollment, the Health Insurance Marketplace took steps to verify more than 160 million of individual pieces of information submitted by consumers from across the country, consistent with the requirements Congress included in the Affordable Care Act. The Marketplace checked to see that consumers are who they said they were, matching Social Security numbers, income and tribal status, among a host of other data points – all to ensure that folks are eligible for coverage and, in many cases, entitled to financial assistance to help them afford their plan. The typical family of four generated 21 separate pieces of information that required verification, and all were attested to under penalty of perjury.
For most consumers, the data they submitted were immediately verified by the Marketplace. But, while most information the applicant provided lined up, sometimes a name or data point didn’t match up right away with existing records. For example, a consumer might have recently changed jobs, but the latest IRS tax return data and other data available to the Marketplace didn’t reflect that change in income. In such cases, the law requires us to double and triple check this data in another way. Those consumers were still able to enroll in Marketplace coverage – as provided for in the law – but, when they enrolled, they received a notice instructing them to submit a little bit more information.
The Marketplace is working around the clock with consumers who were asked to provide additional information in order to double check the information consumers attested to on their application for coverage. In many cases, consumers have already uploaded or mailed in necessary documentation, such as a paystub and extra information cleared up discrepancies other cases require more facts from the consumer, the spelling of a name on a birth certificate doesn’t match the spelling on a license. Our teams are processing this information as quickly as possible.
We are focused on getting this right to help consumers and do due diligence for taxpayers. In most cases we need more facts that only individuals can provide. That’s why, over the next few weeks, we’re again reaching out to these consumers – via mail, email and phone calls – to encourage them to provide supporting documentation so we can resolve any remaining issues with their application as soon as possible. It’s an important part of the process to help ensure that consumers are getting the benefits they’re eligible for and deserve.
As part of our due diligence process and to be a good steward of taxpayer money, if consumers don’t provide sufficient proof to support the information they attested to, they will have their eligibility ended or changed to reflect what is recorded in trusted data sources.
Applying for health insurance online was a new process for many consumers, and it was always expected that some would need to submit additional data so the Marketplace can complete the verification required by the Affordable Care Act. This verification process isn’t unique to the Marketplace; in fact, it’s similar to a process that states have been administering in the Medicaid program since its inception. Under the law, consumers typically are given 90 days in which to submit additional information to verify their information on their application. Most people who applied during open enrollment are still within that window, and, for those who aren’t, we’re giving them extra time to provide documentation as they work through these issues with us – a flexibility the Affordable Care Act provides for the start-up year of 2014.
We remain committed to working with consumers individually – as well as our state and federal partners – to address any issues that may be impacting consumers’ ability to secure quality, affordable health coverage.