The Washington Post
Administration warns some could lose health-care coverage on federal exchange
By Amy
Goldstein August 12 at 8:46 PM
Federal health officials are warning hundreds of thousands of people who have
bought health plans through the federal insurance exchange that their coverage
will be cut off unless they quickly provide proof that their citizenship or
immigration status makes them eligible to be insured through the new
marketplace.
The warnings, in letters
being mailed this week to 310,000 people in the three dozen states that rely on
the exchange, give the recipients until Sept. 5 to send copies of green cards,
citizenship documents or other information showing that they qualify for the
coverage. If they miss the deadline, their coverage will end on Sept. 30.
This move is the first step the administration has taken to hold consumers
accountable when information on their applications conflicts with records on
file at federal agencies or is missing altogether.
The action, announced Tuesday, will affect only people with lingering
eligibility issues involving their citizenship or immigration status. They are
included in about 2 million cases of several kinds of application
discrepancies involving people who have obtained coverage through the
exchange.
Federal health officials said Tuesday that they will take separate action
soon to resolve an even larger group of cases with discrepancies: those in which
the income people listed on their insurance applications is out of sync with
their federal tax records. In cases of unresolved income inconsistencies, the
government could reduce — or eliminate — peoplefs federal insurance subsidies
but could not end their coverage.
These steps are an effort by the administration to ensure, before the second
insurance sign-up period through HealthCare.gov begins in the fall, that
consumers who have such health plans are entitled to the coverage and the
federal tax credits that are helping most of them pay for it.
Technical issues persist
The effort to iron out the differences also reflects the technical problems
that have affected HealthCare.gov since the marketplace opened Oct. 1. These
have included difficulties in the part of the online system designed to verify
applicantsf identity, income and eligibility to buy a health plan.
The notice says in bold letters, gAct by September 5, 2014 or Your
Marketplace Health Insurance May End.h It is being mailed less than two weeks
after 150 organizations representing immigrants and low-income people nationwide
appealed to Health and Human Services Secretary Sylvia Mathews Burwell to let
people keep their coverage for now, regardless of whether their eligibility has
been established.
In a
July 31 letter , the organizations argued that many people
whose eligibility remains in dispute have provided proof of their citizenship or
immigration status, but their paperwork was caught in gsystem errors.h Other
immigrants who still need to send documents, the organizations wrote, will be
unable to understand the federal notices, which are being mailed only in English
and Spanish.
Cutting off coverage gis what we were hoping to avoid,h said Jenny Rejeske, a
health policy analyst at the National Immigration Law Center. gWe donft think
itfs fair.h
Federal health officials said they have been working for two months to winnow
the number of people with unresolved eligibility issues involving their
citizenship and immigration status. As of late spring, after the first sign-up
period in the federal marketplace, there were about 970,000 such cases. About
450,000 of them have been resolved, with no one ruled ineligible, said Aaron
Albright, a spokesman for the Centers for Medicare and Medicaid Services, the
HHS agency responsible for the federal insurance exchange.
Of the remaining cases, slightly more than 200,000 are gin process,h meaning
that a federal contractor hired to verify eligibility, Serco, is comparing
consumersf documents with the records on file in federal agencies — or that
people still are within the window set by federal rules to send in their
documents.
The 310,000 who will receive the warnings have been asked by Serco to furnish
documents, on average, five to seven times by phone, e-mail or mail, Albright
said. Many of those people have never uploaded the necessary documents or sent
them by mail, he said. But in an unknown number of cases, people sent the
information but Serco has been unable to match it with the applications. gPeople
will have to send in their info if we donft have a record of it,h Albright
said.
The 2010 Affordable Care Act, which created insurance marketplaces that began
providing coverage in January, includes rules for who is eligible to buy a
health plan and to receive new federal subsidies. The marketplaces are intended
for people who cannot obtain affordable coverage through a job. In addition to
U.S. citizens, the marketplaces are open to people who are lawful permanent
residents, refugees, foreigners who have been granted asylum and people in a few
other specific immigration categories.
Health policy specialists and advocates for immigrants said that federal
officials must exclude unqualified people from the insurance exchange but that
the timing of the letters and their potential effects are worrisome.
gYou feel very different about someone not getting coverage because they
couldnft give documentation versus someone getting kicked off whofs had coverage
for months,h said Larry Levitt, senior vice president of the Kaiser Family
Foundation, a health-policy organization. gThatfs a function of how chaotic the
systems and the enrollment process have been.h
Leonardo Cuello, the National Health Law Programfs director of health policy,
praised HHS for having repeatedly tried to contact people with citizenship and
immigration issues and for resolving nearly half of those cases in recent
months. Still, he said, gitfs the ones being terminated you lose sleep
over.h
Cuello said that some people donft understand the notices, not realizing that
documents they uploaded electronically or mailed months ago never arrived.
Others have moved, did not receive previous notices and will not receive the new
letter. And some speak languages other than English and Spanish and, with merely
a tag line saying that help is available in their native language, will not
understand the letterfs urgency, he said.
Rejeske, of the National Immigration Law Center, said some consumers could
discover that their insurance has been canceled when they arrive at a doctorfs
office.
gWhile we have concerns about this [HHS] step, we want people to gain
coverage,h she said. gOur main message to consumers is . . . even
if youfve sent in documents, keep doing it until it works.h
In West Palm Beach, Fla., Vicky Tucci, who helps people sign up for the
health plans at the Legal Aid Society, said she plans to turn to local radio
stations for help with urging people to take the letters seriously. When earlier
notices have arrived, relatively few people contacted her for help, she said,
and some of them thought the notices were scams, because they had sent the
proper documentation. In Florida, nearly 94,000 residents are being mailed the
new letters, the most of any state, according to a federal breakdown of
recipients.
In the Washington metropolitan area, nearly 14,000 Virginia residents will
receive the letters. People will be unaffected in Maryland and the District,
which have separate health insurance marketplaces.