Thousands May Have Been Shorted On Insurance Subsidies After Calculation Error
Thousands of families with a disabled or deceased parent聽may have received a lower subsidy than they deserved to buy health coverage through the federal insurance marketplace as a result of a calculation error by the federal government.
In addition, some who should have been聽eligible for Medicaid may have been turned away, leaving them on the hook for higher-priced private insurance coverage. The Centers for Medicare & Medicaid Services has acknowledged the glitch but many details about how the agency will fix it remain unclear.

For months, health insurance assisters who help enroll people in coverage on the federal marketplace, which is relied upon by residents of about three dozen states,聽noticed that聽聽seemed to be making a mistake in how it calculated some families鈥 income to determine whether they qualified for subsidized marketplace coverage, or whether family members might be eligible for Medicaid.
聽seemed to be tripping up in cases where children were receiving Social Security income, generally because a parent has died or is disabled.That鈥檚 because eligibility for marketplace subsidies or Medicaid is based on a household鈥檚 modified adjusted gross income, known as : generally,聽adjusted gross income plus tax-exempt Social Security benefits, interest and foreign income.
The government was including that Social Security income when it computed a family鈥檚 MAGI figure. However, a child鈥檚 income should only be included if the child (or other tax dependent) was required to file his聽or her聽own tax return. A child who only receives Social Security benefits wouldn鈥檛 be required to file.
By adding the child鈥檚 Social Security income to the family鈥檚 income, the marketplace was inflating the family鈥檚 income. The result: Some people were wrongly turned down for Medicaid coverage and others received less in premium tax credits and cost-sharing subsidies than they were eligible for.
In March, the Centers for Medicare聽&聽Medicaid Services acknowledged the calculation error. CMS has advised assisters to help consumers remedy the error by submitting an appeal to the federal marketplace or applying through聽healthcare.gov聽or the state for a Medicaid determination.
Now that officials have acknowledged their error,聽healthcare.gov should do a computer search to identify families that have been affected,聽and ensure they鈥檙e enrolled in the right coverage and receiving as much financial help as they鈥檙e eligible for, says Tricia Brooks, a senior fellow at the Georgetown University Center for Children and Families, who has blogged on this .
CMS hasn’t released a tally of how many families were affected by the glitch,聽but Brooks estimates the number at about 40,000 households. 鈥淭he biggest step they can take is to go back and fix this problem for everyone who鈥檚 currently enrolled and has a wrong determination,鈥 she says.
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