Covered California falls short in verifying data

By From page A10 | July 02, 2014

SACRAMENTO — California’s new marketplace for buying individual health insurance often failed to verify important personal information and discrepancies in the applications it received, a process that is critical in determining whether people are eligible for taxpayer subsidies, according to a federal watchdog report released Tuesday.

Covered California did not resolve inconsistencies in eligibility data, failed to verify people’s citizenship and legal residence, and entered paper applications incorrectly into its enrollment system, according to findings released by the inspector general of the U.S. Department of Health and Human Services.

The state has enrolled 1.4 million people in private health plans. Its 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 that it lacked the resources to resolve all of them.

According to a companion report by the inspector general, there were inconsistencies in the enrollment eligibility of 145,307 applicants 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.

Among its findings for California:

—Information from paper applications was not always entered correctly into enrollment system.

—Citizenship and lawful presence were not always verified through the U.S. Department of Homeland Security.

—Inconsistencies in eligibility data were not always resolved.

—Eligibility data were not always properly maintained.

Covered California’s executive director, Peter Lee, wrote in a response that the state did not entirely agree with the findings. Lee noted that part of the review was based on an early sample of just 45 applications out of 1.4 million enrollments in the state’s first year.

While Covered California agreed that paper applications weren’t always properly processed, inconsistent data was left unresolved and eligibility data not properly maintained, the state said it verifies citizenship and legal residency through both 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.


The Associated Press

The Associated Press


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