Feds: California health exchange lags on verifying

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Covered-California
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SACRAMENTO, Calif. (AP) – California’s marketplace for buying individual health insurance often failed to verify important personal information and resolve discrepancies in applications, a critical process in determining if people are eligible for taxpayer subsidies, a federal watchdog said Tuesday.

Covered California did not resolve inconsistencies in data, failed to verify citizenship and legal residence, and entered paper applications incorrectly into its system, the inspector general of the U.S. Department of Health and Human Services said in a report.

Nationwide, the White House touted that 8 million people signed up in the first open enrollment period under the federal health overhaul. California alone enrolled 1.4 million people in private health plans.

The state’s shortcomings were highlighted in a review of the federal marketplace and the California and Connecticut state exchanges to ensure that accurate information is being submitted for enrollment and tax credits.

“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,” the report said.

The review was requested by congressional Republicans as a condition for ending the budget standoff that partially shut down the government last fall. Republicans said they are concerned that people who are not legally entitled to the government-subsidized private health insurance could nonetheless be getting it.

Covered California responded that it had resolved some inconsistencies but lacked resources to resolve all of them.
“We remain in compliance with federal guidance and are using the audit’s findings as part of our continuous improvement and refinement of our processes and systems,” Covered California Executive Director Peter Lee said in a statement.

A companion report by the inspector general said there were inconsistencies in the enrollment eligibility of 145,307 applicants in California out of more than 500,000 applicants based on early enrollment data from October to December 2013. The vast majority of the inconsistencies were in income and citizenship.

The report said many of the personal details submitted by consumers did not match government records.

Lee wrote in a response to the inspector general that the state did not entirely agree with the findings. He noted that part of the review was based on an early sample of just 45 applications out of 1.4 million enrollments in the first year.

Covered California agreed that paper applications weren’t always properly processed, inconsistent data was left unresolved, and eligibility data not properly maintained. But the state said it verifies citizenship and legal residency through the Social Security Administration and the Department of Homeland Security.

“During the early months of open enrollment, the Federal Services Data Hub was frequently offline, which impacted Covered California’s ability to verify some cases as noted in the audit,” the state wrote.

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