The Affordable Care Act – Proof of Eligibility

One of the most significant provisions in the Patient Protection and Affordable Care Act (a/k/a “Obamacare”) is the requirement that every citizen or legal resident of the United States, with few exceptions, have suitable health coverage. For persons not covered by employer-provided healthcare, coverage can be obtained from the Health Benefit Exchange in their state of residence, primarily through HealthCare.gov.

As everyone knows, HealthCare.gov suffered numerous technical difficulties during the initial 90 days of operation. Certain problems continue including the ability to verify whether a person is eligible to obtain coverage from a Health Benefit Exchange. When the initial enrollment period ended in April 2014, approximately 1,000,000 people had insurance applications with inconsistencies.

Many of these cases have been resolved, but a significant number of persons have not responded to requests for documents to verify their eligibility. On August 12, 2014, letters were mailed to 310,000 persons by the Center for Medicare and Medicaid Services (“CMS”) requesting documentation by September 5. Officials at CMS stated that beginning on September 30, CMS would start to notify insurers to discontinue the policies of persons who fail to provide the requested documentation. With the passage of today’s deadline the coming weeks will tell whether CMS carries out their threat and begins contacting insurers to discontinue policies.