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Health INSURANCE MARKETPLACE
Resolving Citizenship or Immigration Condition Inconsistencies or Data-Matching Bug for People Who Use the Federally Facilitated Marketplace

Last updated AUGUST 27, 2014 | Versión en español (PDF)

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What is meant by "inconsistencies"?

The Federally Facilitated Market place (FFM or "Marketplace") verifies the information consumers provide on their health insurance applications to determine their eligibility for a qualified health plan (QHP). The verification process can consist of several steps.

First, through its data services hub, the Marketplace accesses several electronic authorities databases to verify the data the applicant submits about his or her income, citizenship, immigration status, and other eligibility criteria. If the Marketplace cannot immediately verify all the information on a person's application, the applicant still is immune to buy a QHP and may get subsidies that make the toll more than affordable (premium tax credits to help offset the price of insurance premiums and cost-sharing reductions that lower the toll to the consumer of copays and deductibles).

People whose eligibility isn't immediately verifiable accept 90 days to provide additional documentation to testify they are eligible. This 90-twenty-four hours period is called an "inconsistency period." Most data-matching issues have been awaiting for at least xc days, but until recently the Marketplace was not able to process the copies of documents customers uploaded to the Market'south website or sent in by regular mail. (Applicants should not post their original documents; but copies of documents should exist mailed to the Marketplace.)

There were an estimated 1.4 meg people whose citizenship or immigration status could not be immediately verified when they submitted their applications to the Marketplace. About of these cases have been resolved, just 300,000 Marketplace customers notwithstanding have unresolved inconsistencies. This does not hateful that they are ineligible for coverage, but they might need to submit additional documentation.

What is the Market place doing to articulate upwards inconsistencies?

The Market is focused on resolving the remaining data-matching issues. It has been sending notices to people with unresolved information-matching problems, asking that they upload or post in additional documentation. On August 12, 2014, the Market mailed a final notice warning customers to provide proof of citizenship or immigration status by September five, 2014. If they fail to submit documents by September v, their Marketplace plan will end September 30. Marketplace officials have said that the Market will transport each person who has a citizenship or clearing status inconsistency one notice by regular postal service and volition also telephone the person twice and send him or her one email bulletin.

These notices are in either English or Spanish simply, depending on the language the client indicated he or she preferred. The written notices about citizenship or immigration status information–matching problems also include multilingual taglines directing limited–English proficient (LEP) consumers to call 1-800-318-2596 to talk to an interpreter or to obtain more than information. The taglines do not convey a sense of urgency or alert the consumer that their insurance will end if they do not respond. Taglines are translated into 15 languages: Arabic, Chinese, French, French Creole, German, Gujarati, Hindi, Korean, Smoothen, Portuguese, Russian, Spanish, Tagalog, Urdu and Vietnamese.

What happens if the Marketplace can't resolve an inconsistency?

People with citizenship or clearing status inconsistencies who neglect to provide boosted documentation by September 5 will no longer be considered eligible for a QHP in the Market. Their coverage will cease September 30 and, when they file their 2014 income taxes by April 15, 2015, they may take to pay dorsum whatever premium revenue enhancement credits they received while they were enrolled.

If a person receives a alphabetic character or telephone call maxim that proof is needed to verify his or her eligibility, what should the person do?

To avoid losing their health insurance, consumers who receive a alphabetic character maxim that proof is needed to verify their citizenship or immigration status should mail in or upload copies of documents right abroad, even if they accept already uploaded or mailed in copies of documents. People who accept Healthcare.gov accounts can too log in to their account and click on "Awarding Details" or their "Application Checklist" to run into if they accept to resolve an inconsistency in their application.

The person should follow the steps for each inconsistency to upload or mail in copies of the documents needed to gear up the issue. People who post the documents should include the barcode from the terminal inconsistency notice that was mailed to them. Otherwise, they should write their name and awarding ID number on each certificate copy they postal service.

What if the person already uploaded and mailed in copies of documents?

If the customer already has uploaded or mailed the requested documents but continues to receive notices, he or she can call the Market call center at 1-800-318-2596 to clarify whether boosted documents need to exist submitted. The telephone call center is maintaining a list of people who still demand to submit boosted documentation, which it will update equally new documents are received. People may call to see if they are on the listing and thus need to submit documents, or to confirm that their documents have been received.

Individuals who are told by the Marketplace call centre that they demand to submit additional documentation should repeat the process of uploading or mailing (by regular postal service) copies of their documents to the Marketplace. People who accept resubmitted copies of their documents should then call the Market place call center again to ostend that the documents were received.

What if the documents are received after the September five, 2014, deadline?

Documents received later the September 5 deadline volition still exist candy, but people who submitted their documents late may lose their coverage on September 30. People who lose coverage, simply who then are found to be eligible for a Marketplace programme with subsidies once their documents are candy, will exist immune to reenroll during a special enrollment period. Thus, eligible people who submit documents after the September v deadline may experience a gap in coverage.

Are health insurance customers in states that run their ain marketplaces also at risk of losing their health insurance?

The data in this FAQ pertains only to people who live in FFM and Partnership Marketplace states. States that established their own country-based marketplaces must also resolve customers' citizenship and clearing status information–matching bug, simply may accept unlike procedures, notices, and deadlines. At least some states, nonetheless, are imposing the aforementioned deadline equally the FFM.

Are customers whose inconsistencies are related to income or other not–immigration status factors also at take chances of losing their wellness insurance?

Currently, only Market place customers with citizenship or immigration status data–matching issues are at risk of losing their wellness insurance on September 30 if they do not submit copies of documents proving their citizenship or clearing status by September 5.

Is there anything else a Marketplace customer can exercise?

The online Marketplace had a lot of technical issues during the open enrollment period. Since early March 2014, many workarounds accept been added to the application process in gild to minimize problems related to verifying applicants' clearing status. Therefore, nosotros also recommend that people who have inconsistencies try to resubmit their applications, in addition to uploading or mailing in proof of their immigration condition.

To resubmit an awarding, the person should (1) log in to his or her Marketplace business relationship, (2) select the selection to study a change, (three) review and, if necessary, update the answers about his or her immigration status and immigration document, and (4) resubmit the awarding.

If the person has received a Medicaid deprival considering of non meeting Medicaid'southward immigration status requirements, he or she should also make certain to reply the new questions about receiving a Medicaid denial based on clearing condition.

People who can't access their application online tin call the call eye to update and resubmit their awarding. More information on resolving Marketplace data-matching problems is available on Healthcare.gov, at www.healthcare.gov/blog/the-marketplace-might-need-more-information-from-you/.

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Source: https://www.nilc.org/issues/health-care/resolving-inconsistencies-or-data-matching-problems/

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