The federal health insurance marketplace was unable to resolve 2.6 million of the 2.9 million inconsistencies — 89.6 percent — on applications for enrollment in health plans, according to a report from HHS' Office of the Inspector General.
An inconsistency refers to when application data cannot be verified by information the government has. This does not necessarily mean information on the application is incorrect; rather, the marketplace simply cannot verify an applicant's information with the available data sources, according to the report.
The majority of inconsistencies unable to be resolved dealt with citizenship/national status/lawful presence, totaling 44 percent of all inconsistencies. Income followed, with 33 percent of all inconsistencies.
Resolving inconsistencies regarding Social Security numbers were the most often resolved, accounting for 5 percent of all inconsistencies[asc1].
The report also examined 15 state marketplaces' ability to resolve inconsistencies. Four of the marketplaces — Massachusetts, Nevada, Oregon and Vermont — reported being unable to resolve inconsistencies due to shortcomings in their information technology systems. According to the report, these failures mainly occurred during the enrollment period, so the marketplaces had to enter information manually, causing backlogs. The state marketplaces then shifted resources to process eligibility applications instead of trying to resolve inconsistencies, according to the report.
Seven state marketplaces — Connecticut, District of Columbia, Kentucky, Maryland, New York, Rhode Island and Washington state — reported resolving inconsistencies without delay.
The state marketplaces also reported inconsistencies regarding income and citizenship were the most common.
The report examined data sources from October 2013 to December 2013.
The report suggests CMS develop a public plan detailing how and by what date the federal marketplace will resolve inconsistencies and conducts oversight of the state marketplaces to ensure they are resolving inconsistencies according to federal requirements.
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