CMS to test eligbility verification for special sign-up periods

Stack of documents

The Obama administration has revealed further details about one of the key modifications to the Affordable Care Act exchanges that it proposed last week--pre-enrollment verification for participation in special enrollment periods.

The Centers for Medicare & Medicaid Services will experiment with a pre-enrollment verification system to ensure consumers are legally eligible to find plans during the special enrollment periods (SEPs), according to a frequently asked questions brief (pdf) from the agency. 

SEPs allow consumers to get health coverage after a change in life circumstances, but insurers have complained that consumers exploit loopholes to get coverage during SEPs once getting sick.

RELATED: Under pressure from payers, Obama offers Affordable Care Act fixes

CMS notes that preliminary data suggest the confirmation process was associated with a 15 percent decrease in special enrollment.

The move from CMS comes in the wake of an August op-ed published by USA Today, in which America's Health Insurance Plans CEO Marilyn Tavenner argued that implementing effective pre-enrollment verification for special enrollment periods would go a long way in improving the healthcare law.

Still, “anything that could really depress enrollment is concerning to us,” an analyst from left-leaning healthcare advocacy group, Families USA, told The Hill.

For his part, Healthcare.gov CEO Kevin Counihan said earlier this year that “we continue to review the rules around special enrollment periods in order to keep them fair for consumers and insurers."

CMS amended SEP eligibility requirements in May to ensure the sign-up periods are available only for consumers who had minimal essential coverage for one or more days in the two months preceding a change of residence.

Related: Healthcare industry experts respond to Obama's ACA fixes