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CMS update on consumers who have data matching issues

  • Of 966,000 individuals with citizenship or immigration data matching issues as of May 30th, 851,000 are now closed or in progress, a reduction of 88 percent
  • Of 1.2 million households with income data matching issues as of May 30th, 897,000 households are now closed or in progress; consumers will be getting letters this week asking for information

The Centers for Medicare & Medicaid Services (CMS) is committed to assisting consumers and protecting taxpayers by helping to ensure those who are enrolled in Marketplace coverage meet the eligibility requirements. As CMS prepares for the next Marketplace open enrollment period beginning on November 15, it is resolving data matching issues that occurred during the first year so that its records are accurate before the renewal process begins, and so that consumers have the information they need about their coverage. Throughout this process CMS has worked to maintain coverage for those who have sought it in the Marketplace, while meeting its obligation to the taxpayer to spend its dollars wisely.

Today, the Federal Health Insurance Marketplace (Federal Marketplace) began sending notices to consumers who have an income-related data matching issue. Individuals who do not respond to numerous previous attempts to contact them by September 30, 2014 may see the costs of their coverage change. For instance, this may impact the cost of their monthly premium, deductibles, copays, and co-insurance, and even their tax bill or refund during filing season.

“The Affordable Care Act is working for millions of Americans who are able to access quality health coverage at a price they can afford. In fact, most individuals who selected a plan with tax credit in the Federal Marketplace are paying less than $100 a month in premiums,” said CMS Administrator Marilyn Tavenner. “We are committed to keeping coverage affordable for the millions of Americans who depend on it, and to doing so in an efficient, transparent way that protects taxpayers. It’s critically important that consumers who still owe income-related documents to the Marketplace send them in by September 30 so we can continue to hold down their costs. We are pleased that the number of individuals who were at risk of losing their Marketplace coverage, or seeing changes in their costs because of data matching issues has been dramatically reduced in the last three months.”

Consumers often have more up-to-date information than what’s in CMS data sources. For example, the Marketplace verified income by checking 2012 tax return information, but a consumer could have switched jobs since those returns were filed. Just because CMS is double-checking data and requesting more documentation, doesn’t mean that a consumer has provided false information or that he or she is ineligible for help paying for coverage or health services – it simply means that the information on their application doesn’t match what’s in trusted data sources and therefore has to be verified.

On May 30, there were roughly 1.2 million households with income-related data-matching issues. This represents about 1.6 million people. We’ve made significant progress since then based on an extensive outreach campaign and enhanced operational effectiveness. As of September 14, approximately 467,000 household income data-matching issues have been closed and an additional 430,000 are currently in the process of being resolved. There are still about 279,000 households with unresolved income-related data-matching issues that haven’t sent in supporting information, representing 363,000 individuals. CMS will send letters starting today to individuals who, if they do not send in supporting documents by September 30, may see their costs change.

Income-related data matching notices are being sent in English and Spanish and will provide straightforward instructions on how consumers should submit the necessary information to the Marketplace to help keep their costs down. Those individuals receiving a letter referencing September 30 should log into their HealthCare.gov account and select their current application to upload their documents. They can also mail their information to our consumer center. To facilitate timely processing, consumers mailing in a copy of their documents should include the bar code page from the notice with their documents. Consumers may also contact our call center at 1-800-318-2596 to see what documents they need to submit and check whether the Federal Marketplace has received their information.

A network of partners, local assistors and other stakeholders including community health centers are actively communicating and engaging consumers to help them keep their health insurance and eligibility for financial assistance. Consumers may contact one of our partners in their community to get one-on-one help. To find one of these local partners, visit Find Local Help on HealthCare.gov.

Today, CMS is also providing an update on individuals with citizenship and immigration data matching issues. In August, we sent letters to about 310,000 Federal Marketplace consumers who had not submitted any outstanding citizenship or immigration documents after numerous requests. We’ve made progress in resolving these cases. We received hundreds of thousands of documents in response to the September 5th deadline resulting in a decrease from 966,000 as of the end of May to 115,000 as of September 14. To date, 115,000 individuals with citizenship and immigration data matching issues have not responded to our numerous contacts and will be receiving notices saying their last day of Federal Marketplace coverage is September 30, 2014. Those who submit information that confirms their eligibility after the deadline may be eligible for a special enrollment period to enroll in coverage.

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