Some Vermonters in the health care exchange could get dinged at tax time


MONTPELIER -- There are thousands of inconsistencies in the information Vermonters provided to enroll in health insurance through the state exchange, according to a federal audit.

That could mean hundreds, or even thousands, of Vermonters who received tax credits for their premiums or subsidies to lower their out-of-pocket costs could find they owe money at tax time.

tA report from the Inspector General of the federal Health and Human Services Department released Tuesday found that the federal and state exchanges failed to properly check applicants' eligibility for coverage and subsidies.

Federal investigators found exchanges were mostly unable to reconcile inconsistencies between the information people provided and government data on income, citizenship and other criteria.

Discrepancies aren't indicative of fraud by enrollees, and sometimes people entered information that was accurate to the best of their knowledge but it didn't match up with federal data, according to the report.

The report was compiled using information collected between October and December 2013, and was supported by site visits conducted between January and March with the staff of the federal exchange and officials of all 15 state exchanges.

Vermont's was among four state exchanges that were unable to resolve inconsistencies, while seven others were able to reconcile them immediately. Three reported they were able to match the numbers through their Medicaid offices, the report found.

People who input their income information incorrectly could also be overpaying for their health coverage, said Lawrence Miller, health care reform chief, and they might see some relief when they file taxes next year.

But the problem of getting accurate eligibility information is compounded in Vermont because the exchange website still doesn't allow people to make changes to their coverage online. That has created a backlog of about 10,000 people who need to change their information.

Miller recommended that Vermonters who have tried to submit a change of income to reflect a boost in pay save some additional money each month so they can pay back the excess premium credit they received.

The website was supposed to be able to process changes online weeks ago under a revised contract with CGI, the main vendor building the site, and the state recently hired another company to help plow through the backlog.

State officials have given no indication of when they expect users to be able to make changes online, though Miller reiterated Wednesday that it's the top priority.

"This is not a surprise," said Randy Brock, former Republican gubernatorial candidate and an early critic of Vermont Health Connect.

Before the exchange launched there were questions about whether eligibility calculations were being done consistently and accurately. Brock said he has received numerous reports from insiders that calculations made with the same income information would yield different results.

State officials could have done more to make the public aware of the eligibility problems with Vermont Health Connect and their scope, critics say.

"These are concerns that Vermonters for Health Care Freedom brought up last fall and winter when we were hearing from individuals who were having difficulties with their applications and the calculator," said Darcie Johnston, who leads the 501c4 organization and served as Brock's campaign manager in 2012.

Now Vermonters could be financially penalized for the failures of Vermont Health Connect, Johnston said.

A spokesman for Rep. Peter Welch, D-Vt., said his office was still going through the report, but Welch doesn't believe anyone should be penalized for making a mistake on their application for coverage on the exchange.

Data for Vermont shows there were 15,339 inconsistencies in income information; 8,661 inconsistencies in subsidy eligibility; 2,251 for citizenship information; and 2,200 for eligibility to purchase insurance on the exchange, according to the HHS Inspector General's report.

One enrollee can have multiple inconsistencies, so it is impossible to know how many of the 144,000 Vermonters who signed up for coverage could have inaccuracies in their applications and eligibility determinations.

The report found the federal marketplace wasn't able to resolve 2.6 million of 2.9 million inconsistencies that were found.


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