CMS Takes Stock of Federal Health Insurance Marketplace Benefits

As the Centers for Medicare & Medicaid Services (CMS) continues its efforts to ensure that those who are enrolled in the Federal Health Insurance Marketplace (FHIM) meet eligibility requirements, the ripple effects of these efforts may be felt at medical practices nationwide.

In a news release issued on September 15, 2014, the agency stated that 115,000 people who had not submitted sufficient information to clear up data inconsistency issues relating to their citizenship or immigration status “will be receiving notices saying their last day of Federal Marketplace coverage is September 30, 2014.”1 The potential revoking of FHIM benefits to more than 100,000 Americans may make insurance-verification processes at practices even more complex than they already are.

The statement also states that “there are still about 279,000 households with unresolved income-related data-matching issues that haven’t sent in supporting information [to reconcile differences between the households’ applications and those the CMS has on file], 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.…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.”1

These moves are part of CMS’s preparations for the next Marketplace open enrollment period beginning on November 15, 2014. “[CMS] 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,”1 the news release states.

John V. Cox, DO, Medical Oncologist, Methodist Hospitals of Dallas, TX, and a medical director at Texas Oncology PA, Dallas, said he hopes it will be easy for practices to find out whether their patients’ FHIM coverage remains in place.

“Many plans now have patient coverage information on their computerized systems so you can confirm it right away. So as long as that mechanism remains in place, then practices can use their routine mechanisms to be able to confirm whether a given patient is covered by the FHIM or not,” said Dr Cox in a phone interview.

“I guess we’re always concerned—oncology, urology, and some other practice types that have high-dollar therapeutics that patients are given in their offices—that we’re not going to be told one day that a patient has coverage, then we provide treatment, and then found out on day 2 or day 3 that that coverage doesn’t exist. No practice can suffer the nonreimbursement for these expensive therapeutics. There’s no margin for error.”

Rick Rutherford, Director, Practice Management, American Urological Association, is also hoping for the best for urology practice managers.

“Because the health exchange insurance policies have the 90-day grace period for unpaid premiums already in place, this new development—the termination of coverage for lack of citizenship or income-­verification documentation—is just another administrative hassle,” Mr Rutherford wrote in an e-mail. CMS announced on August 12, 2014, that its staff had sent out reminder notices to 310,000 people2—including 93,800 to Florida addresses and 52,700 to Texas residents3—who had inconsistencies in their citizenship and/or immigration information. These individuals had not responded to 5 to 7 previous requests via e-mail, phone, and regular mail about inconsistencies. There was a September 5 deadline for submitting information to clear up the data-matching issues, and a September 30 FHIM-benefit cutoff date for people whose submissions had not cleared up the inconsistencies.

September 30 was also the date that costs could change for people who had not cleared up income inconsistencies; CMS also said it had made “numerous previous attempts” to reach these individuals since May 30.1 The news release stated that individuals still can clear up inconsistencies in several ways: by logging into their account and selecting their current application to upload their documents, mailing their information to the CMS’s consumer center, or calling the CMS’s call center at 800-318-2596 to see what documents they need to submit and check whether the Federal Marketplace has received their information.


  1. Centers for Medicare & Medicaid Services. News release September 15, 2014. CMS update on consumers who have data matching issues.­2014-Press-releases-items/2014-09-15.html. Accessed September 16, 2014.
  2. Centers for Medicare & Medicaid Services. News release August 12, 2014. Federal Health Insurance Marketplace: Send in requested documents now to keep marketplace coverage. Accessed September 15, 2014.
  3. Centers for Medicare & Medicaid Services. Warning notices generated for citizenship/immigration data matching issues (Individual Level) by State Data as of 8/10/14. Accessed September 16, 2014.

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