Following the expiration of the Covid-era enhanced Obamacare subsidies at the end of last year, the corporate media have remained focused on how much Exchange enrollment might decline this year. But a new report issued by the Department of Health and Human Services (HHS) provides another perspective on the issue.
Official reports by the Congressional Budget Office and Government Accountability Office have previously examined how applicants misstate their income to qualify for subsidies and how Exchanges permitted enrollment of fictitious applicants. But the data HHS analyzed gives additional context and granular details surrounding improper enrollments into Exchange coverage. It provides yet another reminder that “success” should not merely consist of the number of people (real or otherwise) enrolled in government programs — and that Congress and the administration should take additional action to guard against fraud.
Individuals removed
The report shows two facets of the same story: groups of individuals who have been disenrolled over the past year and additional groups still enrolled who show signs of questionable activity. The report reveals how the Centers for Medicare and Medicaid Services (CMS) removed enrollees over the second half of last year due to various program integrity efforts.
As the graphic below shows, two rounds of Medicaid periodic data matching (PDM in the chart) — i.e., removing people enrolled simultaneously in Medicaid and Exchange subsidies — culled the rolls by about 550,000. Likewise, CMS also removed approximately 665,000 enrollees who did not file federal taxes to reconcile the subsidies they received in prior years (which are based on projected income) with the subsidy amounts they should have received based on actual income (i.e., failure to reconcile, or FTR in the chart).
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