Avoidance of Future Improper Payments. For advance payments of the premium tax credit (APTC), consumers must reconcile the tax credit at the time of tax filing, and so improper payment is mitigated. For state and federal costs associated with Medicaid coverage, the avoidance of future improper payment is not quantified here. However, the use of matching programs mitigates the risk of fraud and abuse by applicants or third parties by requiring that personal information provided on an eligibility application match known data on the individuals.
Avoidance of Future Improper Payments. Agencies: o Source (VA): N/A o Recipient (SPAAs): Total for All State Agencies, Per Year: $221,427,016 o Facilitating Agency (HHS/ACF): N/A o DOD/DMDC: N/A o Justice System Agencies: unknown • Public Assistance Clients: improved service delivery to clients, by using computer matching instead of a manual process to determine eligibility; increased resources and less participation stigma for intended program beneficiaries, due to screening out improper beneficiaries • General Public: increased public support for and confidence in the public assistance programs benefitted by the matching program; savings to taxpayers resulting from improved program integrity and efficiency
Avoidance of Future Improper Payments. To Agencies – • Source Agency (OCSE) – N/A • Recipient Agency (SSA) The benefits realized by SSA from this matching operation include the reduction of incorrect monthly benefit payment amounts and the detection and recovery of retroactive overpayments. For FY 2021, the total benefits SSA realized from this matching operation is approximately $104,190,336. Avoidance of future improper payments Reduction of future monthly benefit payment amount The systems selected approximately 118,993 CDR cases using quarterly earnings. Of these 118,993 cases, 10,728 cases resulted in termination of monthly benefit payments. The average monthly benefit payment amount was $1,214. The total adjustment in reduced monthly payment amount was $13,023,792. We conservatively predict that without this matching operation these incorrect payments would have continued for 8 months, costing SSA $104,190,336. Therefore, in FY21, we observed a savings of approximately $104,190,336. • Justice Agencies N/A To Clients – N/A To the General Public – N/A
Avoidance of Future Improper Payments. To Agencies • Source Agency: OCSE • Recipient Agency: SSA Quarterly Batch Matching Operation Between October 2019 and September 2020, SSA Systems reported matching 342,941 NDNH records and sending 251,366 S2, 80,233 S7, and 11,342 U5 alerted cases to the FOs for additional development. The FOs worked all these alerts. Development of the match alerts resulted in a decrease in the recurring monthly payment in 0.75 percent of the S2 cases. The average monthly decrease was $78 and the total decrease in monthly payments for the sample cases was $233. If the match had not occurred, we assume that this incorrect payment would have continued for three additional months. Therefore, the estimated savings due to the prevention of erroneous future monthly payments would be about $441,090 when we project the results to the universe of alerts released in FY 2020. Approximately 15.25 percent of the S7 cases analyzed had a decrease in the monthly payment amount. The average monthly payment adjustment was about $345 for a total reduction of $21,056. Based on the assumption that this incorrect payment would have continued for three additional months, we estimate the potential savings due to prevention of future incorrect payments would be about $12,664,260 for the entire universe of FY 20 alerts. We determined that the FO did not reduce the recurring monthly payments in any of the U5 cases in FY 20. We found that approximately 3.5 percent of the S2 alerts sampled had an increase in the monthly payment. The average monthly payment adjustment was about $368, resulting in a total underpayment of $5,154. Assuming the incorrect payment would have continued for three additional months, we project the potential underpayment for the universe of S2 alerts would be about $9,712,992. Reviewing the S7 alert, we found retroactive underpayments in approximately 2.75 percent of the cases analyzed. The average underpayment per underpaid case is $2,159 for the year. Projecting these results to the universe of S7 alerts released in FY 2020, we estimate that 2,206 cases have retroactive underpayments detected from the match, which total approximately $4,762,754 for FY 2020. Approximately 13.75 percent of the S7 cases analyzed had an increase in the monthly payment amount. The average monthly payment adjustment was about $238 for a total underpayment of $2,625,616. Based on the assumption that this incorrect payment would have continued for three additional months, we estimate the potential un...
Avoidance of Future Improper Payments. For advance payments of the premium tax credit (APTC), consumers must reconcile the tax credit at the time of tax filing, and so improper payment is mitigated. For state and federal costs associated with Medicaid coverage, the avoidance of future improper payment is not quantified here. However, the use of matching programs mitigates the risk of fraud and abuse by applicants or third parties by requiring that personal information provided on an eligibility application match known data on the individuals. Recovery of Improper Payments and Debts Not applicable, because data from the Marketplace matching programs are not currently used to identify and recover improper payments and debts.
Avoidance of Future Improper Payments. For advance payments of the Premium Tax Credit, consumers must reconcile the tax credit at the time of tax filing, and so improper payment is mitigated. For state and federal costs associated with Medicaid coverage, the avoidance of future improper payment is not quantified here. However, the use of matching programs mitigates the risk of fraud and abuse by applicants or third parties by requiring that personal information provided on an eligibility application match known data on the individuals. Recovery of Improper Payments and Debts Not applicable, because data from the Marketplace matching programs are not currently used to identify and recover improper payments and debts. Matching Program Structure The Patient Protection and Affordable Care Act, Public Law No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law No. 111-152 (ACA) requires that each state develop secure electronic interfaces for the exchange of data under a matching program using a single application form for determining eligibility for all state health subsidy programs. CMS has entered into matching agreements with the following federal source agencies: 1) Social Security Administration (SSA), 2) Department of Homeland Security (DHS), 3) Internal Revenue Service (IRS), 4) Veterans Health Administration (VHA), 5) Department of Defense (DoD), 6) Office of Personnel Management (OPM), and 7) the Peace Corps. In addition, CMS has developed a matching program that is executed with every state AE, including state Medicaid and CHIP agencies and State-based Marketplaces. CMS designed the Federal Data Services Hub (Hub) to be a centralized platform for the secure electronic interface that connects all AEs and trusted data sources. Without the Hub, each State AE would be required to enter into a separate arrangement with each federal agency to determine whether applicants for state health subsidy programs are eligible for coverage. If the match operations were conducted through separate arrangements outside of the Hub, the costs to CMS, the source federal agencies, the AEs, and consumers (applicants) would be significantly greater than under the current structure. Background assumptions CMS has made the following assumptions in developing this CBA: The ACA does not expressly mandate the use of computer matching, but effectively requires it by requiring a single streamlined application process for consumers. Because matching must be conducted to provide th...
Avoidance of Future Improper Payments. Quarterly Batch Matching Operation No. of Alerts Completed by FO in FY 2017 S2- 271,957 S7 - 81,376 U5 - 12, 738 Change in Monthly Payment Amount Percent of alerts with Change in Monthly Payment Amount 62% 4.3% 4.4% 41.6% Number of Alerts with Change in Monthly Payment Amount 168,613 3,499 3,581 5,299 Average Change in Monthly Payment Amount $415 $390.45 $311 Average underpayment for FY 2017 $3904.48 Total Change in Ongoing Monthly Payment $69,974,395 $1,398,201.45 $ 1,647,989 Total underpayment for FY 2017 $13,666,776 Projected for 3 months $209,923,185 N/A* $4,194,604 $ 4,943,967 Total Benefit $ 214,867,152 *A change in monthly payment occurs because an underpayment is not a monetary benefit to the Social Security Administration. Therefore, the change in monthly payment amount for S7 alerts is not applicable. The benefit change creates an increase in customer service benefit. Quarterly Access to OCSE’s NDNH Online Database SSI Ticket to Work Number of online queries in FY 2017 6,700,000 840,000 Estimated average program savings per query $58.20 659.28 Preventions and estimated overpayments recoveries of retroactive/Cost avoidance $389,900,000 $553,800,000 Total Benefit 943,700,000 Unit cost of work CDR7 $659.28 Estimated8 number of work CDRs avoided 840,000 Savings from not working CDRs $553,800,000 Total Benefits $553,800,000 Estimated average title XVI program savings per query $58.20 Number of XVI queries 6,700,000 Total SSI online query program savings $389,900,000 Total Benefits $389,900,000
Avoidance of Future Improper Payments. To Agencies – • Source Agency (OCSE) – N/A • Recipient Agency (SSA) – Not applicable at this time. • Justice Agencies – N/A To Clients – N/A To the General Public – N/A
Avoidance of Future Improper Payments. For advance payments of the Premium Tax Credit, consumers must reconcile the tax credit at the time of tax filing, and so improper payment is mitigated. For state and federal costs associated with Medicaid coverage, the avoidance of future improper payment is not quantified here. However, the use of matching programs mitigates the risk of fraud and abuse by applicants or third parties by requiring that personal information provided on an eligibility application match known data on the individuals.
Avoidance of Future Improper Payments. Quarterly Batch Matching Operation S2 S7 U5 Alerts Completed by FO in FY 2020 251,366 80,233 11,342 Decreases in Monthly Payment Amount Percent of alerts with Decrease 0.75% 15.25% 0% Projected Alerts with Decrease 1,885 12,236 0 Average Decrease in Monthly Payment Amount $78 $345 0 Total Decrease in Ongoing Monthly Payment $147,030 $4,221,420 0 Projected for 3 months $441,090 $12,664,260 $ 0 Total Benefit -Quarterly Batch $ 13,105,350 S2 S7 U5 Alerts Completed by FO in FY 2020 251,366 80,233 11,342 Increases in Monthly Payment Amount Percent of alerts with Increase 0.75% 15.25% 0% Projected Alerts with Increase 1,885 12,236 0 Average Increase in Monthly Payment Amount $78 $345 0 Total Increase in Ongoing Monthly Payment $147,030 $4,221,420 0 Projected for 3 months $441,090 $12,664,260 $0 Retroactive Underpayments Percent of alerts with Underpayment 0% 2.75% 1.75% Number of Alerts with Underpayment 0 2,206 198 Average underpayment amount 0 $2,159 $890 Total underpayment for FY 2020 $0 $4,762,754 $176,220 Access to OCSE’s NDNH Online Database Estimated Overpayment Recovery Avoidance SSI Query DI Query6 Estimated number of online queries in FY 2020 6,700,000 840,000 Estimated average savings per query $61.227 $952.628 Estimated Savings from Preventing Overpayments and Retroactive Recovery Costs $410,174,000 $800,200,800 Total Benefit – Overpayment and Recovery Cost Avoidance $1,210,374,800 Total Benefits – Access to NDNH Online Database $1,210,374,800
