More Than 2M ACA Applications Have Data Discrepancies, HHS Says

June 5, 2014 in News

Existing system access and functionality of the federal health insurance exchange could hinder efforts by federal officials to reconcile data discrepancies between coverage applications and federal records for millions of U.S. residents, according to a federal document obtained by the Associated Press, the AP/Sacramento Bee reports.

Details of Data Discrepancy

On Wednesday, federal officials confirmed that applications for about one in four U.S. residents — or about 2.2 million people — who enrolled in subsidized coverage through and federal call centers have data discrepancies (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).

If individuals’ data discrepancies remain unresolved, it could affect:

  • What they pay for coverage;
  • Their legal right to benefits; and
  • The amount of subsidies they are eligible for under the Affordable Care Act (AP/Sacramento Bee, 6/5).

In response to the issue, CMS on Wednesday released guidelines designed to help individuals who need to submit additional or corrected information to the agency (Viebeck, The Hill, 6/4).

System Issues

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.

The document stated, “Current system access and functionality … limits the ability to resolve outstanding inconsistencies.” It added, “A phased approach is proposed, initially leveraging manual processes.”

However, 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.

Officials said they expect to have most of the discrepancies resolved by the end of the summer (AP/Sacramento Bee, 6/5).


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).

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