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HealthCare.gov subsidy eligibility flawed, OIG finds


The U.S. Department of Health and Human Services has been struggling to verify whether consumers who signed up for insurance coverage through HealthCare.gov are actually eligible for the subsidies they received, according to a report from the Office of Inspector General.

From October to December of last year, the OIG determined there were 2.9 million inconsistencies regarding subsidy eligibility, and that HHS had resolved 2.6 million of those discrepancies. If it turns out that consumers aren't actually eligible, many of them might be unable to afford their coverage, meaning insurers could lose members.

Essentially, HealthCare.gov couldn't validate consumers' Social Security numbers, while California's state-based exchange struggled to verify citizenship and Connecticut's marketplace couldn't prove identity. "The deficiencies in internal controls that we identified may have limited the marketplaces' ability to prevent the use of inaccurate or fraudulent information when determining eligibility of applicants for enrollment in qualified health plans," the OIG said.

But White House Press Secretary Josh Earnest said the OIG's findings were primarily based on "outdated information" from the open enrollment period when HealthCare.gov was suffering from multiple glitches and technical problems, Reuters reported.

And the Centers for Medicare & Medicaid Services said it's already working to fix the problems with subsidy eligibility. "CMS is working expeditiously to resolve inconsistencies to make sure individuals and families get the tax credits and coverage they deserve and that no one receives a benefit they shouldn't," CMS spokesman Aaron Albright said, reported The Hill's Healthwatch. "We are actively reaching out to consumers to provide additional information that supports their application for coverage and verifying their information every day."

To learn more:
- here's the OIG report (.pdf)
- read the Reuters article
- see The Hill's Healthwatch article

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