Christine Stuart photo

(Updated 3:19 p.m.) More than 16,000 households who signed up for private insurance on Connecticut’s insurance exchange are waiting for their financial documents to be verified and another 7,000 are in danger of losing their coverage because they have failed to submit required documents, according to Access Health CT CEO Jim Wadleigh.

There have been about 50 to 75 consumers a week calling Access Health CT in a panic because they have learned they were no longer covered, Wadleigh said Tuesday.

They may have lost coverage because they failed to provide the financial documents necessary to verify their income. But another 16,000 consumers are waiting to have their financial documents verified by Xerox, the Department of Social Services vendor that validates consumers’ information with the federal government. An applicant has 90 days to provide additional verification documents from the time they enroll or to make a change to their income or family size.

Wadleigh said the 16,000 consumers waiting to have their documents verified are not in danger of having their coverage terminated, even if the 90 day period expires before the vendor is able to complete its verification. During a conference call with reporters, Wadleigh said he doesn’t believe that anyone has lost coverage at this point as a result of verification delays.

Wadleigh also said he didn’t believe it was a problem with the system.

The system generates a lot of paperwork and every time a consumer updates their financial information a new application is created and a new letter is sent to the consumer asking for documents to prove income. Those multiple applications, in addition to the notices requesting verification documents, cause a “snowball effect” and creates confusion for consumers, Wadleigh said.

The system requesting the information from consumers generates up to five reminder notices that give consumers 90 days to respond. If the documents are not received by the end of the 90-day period a consumer could lose their health care coverage or have their subsidy reduced. Termination letters started going out to consumers in mid-February, but Wadleigh said the calls didn’t start coming in to the call centers until June.

There have been 11,000 consumers since November who have had their coverage terminated because they failed to submit any financial documentation, Wadleigh said.

In order to begin to address the problems, which have existed since at least as far back as February, Wadleigh said they are adding 10 additional customer service staff to the resolution line to deal with the increased number of calls.

A press release also says any consumer who is three to four weeks away from having their insurance terminated because they have not submitted appropriate documents will receive a robo call reminder.

Going forward, Wadleigh said Access Health CT will be making system enhancements to minimize the risk of individuals losing coverage or their subsidy. He said he also will re-negotiate Access Health CT’s contract with its call center vendor — Virginia-based Maximus — to improve responsiveness to consumers, and he will be looking into possibly finding a new vendor to handle the verification of documents in an acceptable and timely manner. The exchange does not have a direct relationship with Xerox — the company’s contract is with the Department of Social Services.

Access Health CT and the Department of Social Services jointly administer a shared system to manage Connecticut’s implementation of the Affordable Care Act.

“Ironically, delayed processing of verifications has allowed members to remain enrolled longer and/or allowed their premium subsidies to remain unchanged longer,” DSS Spokesman David Dearborn said.” In other words, the customers have actually benefitted. Now, with the contractor completely caught up, the adverse action notices are being received, and this is what’s prompting the concern about the 7,000 who are potentially losing coverage or subsidy share.”

Asked why Xerox was behind on the verification process in the first place, Dearborn said that DSS and Access Health CT have been working on ironing out system issues, including with Deloitte, the shared information technology vendor with which Access Health contracts directly.

“One of the long-time issues that’s still being worked on is a problem with so-called multiple initial applications at the Access Health gateway, which puts more extra remedial work on the plate of Xerox downstream,” he said. “Our folks are indicating that this issue is one of the reasons for the past verification delays.”

An Access Health spokeswoman said that while Xerox may be caught up on verifying the income documents of Medicaid recipients, it’s not caught up on Access Health enrollees.

DSS, for its part, says Xerox is caught up on all verifications back to the agreed-upon timeframe of March 2015, which was agreed upon by DSS and Access Health.  Xerox cannot distinguish between programs such as Medicaid or Qualified Health Plans before processing, so documents were processed in order of receipt.

Wadleigh said they are trying to put pressure on Xerox to get caught up, but “we don’t have a time frame for that work to be finished.”

Wadleigh said they would like to have their own vendor to verify income for their private health insurance consumers in the future and are working on making that a reality.