Debt deal tightens oversight of state health benefit exchange marketplace subsidy eligibility

The continuing appropriation measure to reopen the partially shuttered U.S. federal government and extend the federal debt ceiling approved by Congress today and expected to be approved by President Barack Obama contains provisions aimed at better ensuring state health benefit exchange enrollee eligibility for premium and cost sharing subsidies.  They require the federal Department of Health and Human Services (HHS) to do the following:

  • Require state health benefit exchanges pre-verify the eligibility of individuals applying for premium tax credits and cost sharing reductions and certify it has done so to Congress
  • By January 1, 2014, detail the procedures used by the exchanges verify eligibility for premium tax credits and cost-sharing reductions in a report to Congress
  • Report to Congress by July 1, 2014 on the effectiveness of the procedures and safeguards provided for preventing the submission of inaccurate or fraudulent information by applicants for enrollment in a qualified health plans offered through the exchange marketplace.

Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email or call 530-295-1473. 

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Frederick Pilot

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