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Capitol Health Call
August 13, 2014

Verifying Eligibility for Insurance and Subsidies Problematic for Exchanges

JAMA. 2014;312(6):589. doi:10.1001/jama.2014.10026

Federal and state health insurance exchanges were unable to verify the eligibility of many applicants for health coverage under the Affordable Care Act, stated a July 1 report to Congress by the Inspector General for the Department of Health and Human Services (http://1.usa.gov/1rfaZoq). The Centers for Medicare & Medicaid Services (CMS) operates the federal marketplace and oversees the health exchanges for 36 states. Because CMS’ eligibility system was not fully operational as of the first quarter of 2014, the federal marketplace couldn’t resolve 2.6 million of 2.9 million inconsistencies on applications for insurance and premium subsidies, according to the report.

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