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CMS Oversight of Eligibility Determinations at State-Based Marketplaces

Centers for Medicare & Medicaid Services provides general oversight over States that elected to establish their own marketplaces. Prior OIG work identified issues with State-based marketplaces' internal controls involving eligibility and enrollment. Thus, we will assess Centers for Medicare & Medicaid Services's oversight activities of seven State-based marketplaces (SBMs) to ensure that individuals were determined eligible for qualified health plans and insurance affordability programs according to Federal requirements. As part of this review, we will (1) summarize the results of our reviews of seven SBMs, which determined whether SBM internal controls were effective in ensuring that individuals were enrolled in qualified health plans according to Federal requirements; (2) assess Centers for Medicare & Medicaid Services's efforts to address the deficiencies identified in our audit reports; (3) assess Centers for Medicare & Medicaid Services's various review processes of the SBMs; and (4) contact the SBMs to understand how they worked with Centers for Medicare & Medicaid Services to establish internal controls over eligibility determinations.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services CMS Oversight of Eligibility Determinations at State-Based Marketplaces Office of Audit Services W-00-15-42024 2017

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