The CMS’ inability to properly manage eligibility checks on Obamacare insurance marketplace enrollees remains a problem more than three years after the market’s balky roll out, according to a federal watchdog.
The Office of Inspector General at HHS said in a 25-page report released Friday that the eligibility check failings “do not necessarily indicate that an applicant inappropriately enrolled” in a health insurance plan or cost subsidy program.
On the other hand, the so-called “federal marketplace,” a website and a complex set of programs and interfaces behind it, won’t be able to ensure that applicants meet their eligibility requirements until the CMS does a better job managing “inconsistencies” in information reported by the enrollee with information from federal and other data sources, the agency said.
An earlier OIG audit in 2014 found the marketplace was unable to resolve 2.6 million of the 2.9 million such inconsistencies it encountered during the program’s initial and tumultuous open enrollment period of Oct. 1, 2013 through March 31, 2014. Most of those issues — 77% — related to citizenship or income, the OIG said.
At rollout in 2013, the marketplace software suffered multiple crashes, prompting individuals to try and submit multiple applications, which exacerbated the number of inconsistencies generated by the system.
At the time, the marketplace fully or partially served 36 states.
In a follow-up audit in 2015, the OIG found the CMS continued to fail to resolve inconsistencies stemming from the eligibility requirements. The watchdog also said the agency did not always manage applicant data and documentation of eligibility problems properly.
Now, more than three years after the rollout, just under half of the inconsistencies from that first enrollment period appear to have been either resolved or simply expired due to timing deadlines for their resolution, the GAO found.
“Even through the 2015–16 open enrollment period, CMS remained unable to identify unique inconsistencies and unique applicants with inconsistencies,” Friday’s report said.
The agency recommended the CMS improve its management of the inconsistency resolution process and refine its data management system to better track issues.
The CMS concurred with the recommendation, adding that over subsequent open enrollment periods it has “significantly reduced” the eligibility inconsistency issues.