HHS Says More Than 2M ACA Applications Have Data Discrepancies

Federal officials this week said the applications from about one in four U.S. residents -- or about 2.2 million people -- who enrolled in subsidized coverage through the health insurance exchanges have discrepancies with federal records, the AP/Sacramento Bee reports.

The data inconsistencies were first reported by the Associated Press, which obtained a federal document that highlighted the issues, as well as the major effort it would take to resolve them (Alonso-Zaldivar, AP/Sacramento Bee, 6/5).

Of those who had information on their applications that differed from federal data, CMS officials said:

  • 1.2 million individuals filed applications with inconsistent information about their annual incomes;
  • 505,000 individuals filed applications with inconsistences about their immigration status; and
  • 461,000 individuals filed applications with inconsistent information about their citizenship (Morgan, Reuters, 6/4).

In an effort to reconcile the application discrepancies, CMS on Wednesday released guidelines designed to help those individuals who need to submit additional or corrected information to the agency (Viebeck, The Hill, 6/4).

If individuals' application issues remain unresolved, it could affect:

  • What they pay for coverage;
  • Their legal right to benefits; and
  • The amount of their ACA subsidies.

CMS' Office of Communications Director Julie Bataille said about 60% of affected applications fall within the 90-day window the ACA provided CMS to reconcile enrollment issues. However, the document provided to AP describes the huge effort it will take to resolve the problems and notes it will mostly require hands-on attention from a large group of employees from government contractor Serco (AP/Sacramento Bee, 6/4).


Bataille said, "The fact that a consumer has an inconsistency on their application does not mean there is a problem on their enrollment," adding, "Most of the time what that means is that there is more up-to-date information that they need to provide to us" (AP/Modern Healthcare, 6/4).

CMS spokesperson Aaron Albright said, "Two million consumers are not at risk at of losing coverage -- they simply need to work with us in good faith to provide additional information that supports their application coverage and we are working through these cases expeditiously" (Reuters, 6/4).

However, House Energy and Commerce Committee Chair Fred Upton (R-Mich.) said the "exchanges are still not built, and accurate information remains hard to come by." He added that federal officials "allowed applications to be processed before the information provided was fully vetted and verified" even though they knew "the system to process these discrepancies is still incomplete" and there is only "an antiquated mail and phone system to address the millions of questions in applications" (The Hill, 6/4). 

Carol Frandsen
My daughter has been on Medi-Cal since the Healthy Families Transition las spring. She just got a letter of acceptance last month. WT? I am assuming it had something to do with the info I input with CoveredCA. Likewise, I received a letter of denial from Medi-Cal and a letter of qualifying for a plan under CCA---I signed up for and was approved last October and started my plan Jan.1 !! Furthermore (yes...), 2 weeks ago I received SIX letters in one day telling me of my approval and what subsidy I qualified for---all 6 had different amounts. There is nothing you can do except ignore them and hope nothing with your current situation gets messed up. You can NEVER get through to anyone on the phone, and it you do, they just seem to think your from another planet trying to explain your situation. I wonder how much time and money it cost just to send me and my daughter all that mis-info?? Times that b the thousands of others...oy vey.
Kathy Sowers
Anytime anyone submits information online with multiple questions, and I'm even including registering for a conference with basic name, title, organization name, e-mail and phone number, my experience (at the receiving end of the submissions) is that many people are not conscientious about what they fill in. Anything can happen, and I am not surprised at this outcome, as the process allows for human beings in a hurry or frustrated to fill in the blanks just so they can complete the process. The end result is one huge headache.
Hatti Hamlin
So, if 60% of these individuals are within the 90-day window, that means 40% (800,000) are not. Assuming many of them used medical services in the last five months and are not legally entitled to coverage, who gets stuck with the bill? Once again, uncompensated care, claims denials, etc.!

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