Federal regulations bring delays to ACA milestones August 19, 2013 General Affordable Care Act, Covered California, Health Care Reform 0 Deadlines and milestones relating to the Affordable Care Act (ACA) are beginning to slide, as the federal government gets a better picture of how capable it will be of implementing the massive changes called for in the law. In July, the federal government announced that the penalty on employers for not providing employees health insurance would be delayed until 2015, while also scaling back income verification requirements that would have been used to determine subsidy levels for individuals purchasing coverage through the new insurance marketplaces. The income verification announcement, which came as part of a 606-page rule published by the U.S. Department of Health and Human Services (HHS), said the requirement that exchanges verify consumers’ income and health insurance status would be delayed until 2015. As a result, consumers purchasing coverage through state-based insurance exchanges, which are scheduled to go live in January 2014, may be self-attesting to both their income and the availability of employer-sponsored coverage until federal verification processes are fully functional. Under the ACA, consumers with incomes ranging from 138 percent to 400 percent of the federal poverty level will be eligible to purchase subsidized coverage through online marketplaces known as exchanges. In addition to the income requirements, enrollees must also not have access to health insurance through their employer to receive subsidies for exchange coverage. HHS stated that a more comprehensive pre-clearance process is currently “not feasible” due to “operational barriers” and “a large amount of systems development on both the state and federal side, which cannot occur in time for October 1, 2013.” The agency did, however, pledge that “a more robust verification process” is in development and should be ready for the 2015 plan year. With verification delayed until 2015, implementation of both the income and coverage requirements will be reliant on self-reporting by potential enrollees, leaving the system ripe for gaming, according to many observers. Such observers have cited figures like the 21 to 25 percent of those receiving the Earned Income Tax Credits who are not eligible. These and other enrollees, who may unintentionally misrepresent income, may also be in for an unpleasant surprise come tax filing for the 2014 tax year, as they will be asked to pay back all or a significant portion of excess subsidies received. According to the rule, the federal government will be conducting random checks of coverage status and income levels in the states where they will be operating exchanges, but noted that the 17 state-based exchanges will have until 2015 to begin their random checks. It remains to be seen how Covered California, one of the 17 state-based exchanges, will handle the new delay. Comments are closed.
