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Coverage and Subsidy Issues Explained

by Christine Stuart | Aug 22, 2014 7:00am
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Christine Stuart file photo

Access Health CT storefront in New Britain

The Access Health CT Board of Directors got an update Thursday on a situation CTNewsjunkie was first to report back in July about why some of its customers were losing coverage or seeing a change in their subsidy.

An operations analyst told the board of directors that they started hearing from consumers as early as May that they had lost their subsidy or their subsidy had changed.

“This in itself is not a unique scenario,” Matthew Lynch, an operations analyst, said. “Throughout most of open enrollment we had individuals saying their subsidy had changed or disappeared.”

He said upon reviewing the data most was as a result of changes in income, which was not a system issue. However, the volume of calls they were receiving about this was “concerning.”

When the cases were reviewed they discovered there were other reasons this was happening.

Two of those were systemic and one he attributed to “worker error.”

He said one of the system errors zeroed out the subsidy for certain customers when their information was shared with the insurance carrier. He attributed another issue to an error in what’s called an 834 form. It’s how Access Health CT gives the insurance carriers information about a customers’ request. During transmittal of the form, the subsidy was zeroed out.

“If an applicant did certain things, a certain way it triggered this issue,” Lynch said.

He said they identified that there was a systemic problem on July 1. In order to stop this from happening to more customers they added a filter so no new problems would occur. A permanent fix was issued on July 18.

The health insurance exchange estimated in early July that “potentially 5,700 customers were impacted,” Lynch said.

All of those 5,700 customers received a letter explaining the situation and what Access Health CT planned to do by contacting them and redetermining their eligibility. After the redetermination process Lynch said they figured out that “2,400 were negatively impacted” by the issue. Of those 2,400 about 900 of those customers lost coverage completely.

Lynch said all of those 2,400 customers had their information corrected.

There are an estimated 77,700 customers enrolled in plans with one of the three private insurance carriers and about 60,847 receive subsidies, according to the most recent information from Access Health CT.

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