Audit: Thousands of dependents ineligible for health coverage
By DEBORAH STAYMAN and SHERRY HALBROOK
Approximately 18,700 dependents covered under the NYS Health Insurance Program (NYSHIP) were removed last summer as the result of an audit of the eligibility of covered dependents.
However, that’s just the dependents who were removed voluntarily or during an amnesty period in 2009.
Thousands more dependents are being dropped from coverage involuntarily because Budco, the contractor hired by the state Department of Civil Service (DCS) to conduct the audit, received inadequate or no documentation from enrollees to verify the dependents’ eligibility for coverage.
The deadline for submitting proof of eligibility was extended to November 25, 2009. NYSHIP enrollees on military leave whose dependents have not been confirmed eligible have not lost coverage for those dependents.
According to Budco, more than 5,600 covered dependents of PEF-represented enrollees have been ruled ineligible, because either no documentation of eligibility was received, or it was incomplete. The affected enrollees were notified, and some of them are appealing that loss.
“Clearly, covering thousands of ineligible dependents has been an increasingly heavy and unfair burden NYSHIP enrollees and their employers have been shouldering for too long,” said PEF President Ken Brynien. “The eligibility verification process has been arduous for some of our members but, ultimately, the resulting fairness and savings should be worth that effort.”
In its $4.3 million contract to perform the eligibility audit, Budco promised to save NYSHIP at least $12.9 million by removing ineligible dependents.
So far, PEF has not been told the actual amount of savings. Initially, that savings will be experienced by the Empire Plan and HMOs that insure the NYSHIP enrollees. They are projecting fewer claims for 2010, so savings are passed on to the state and NYSHIP enrollees as lower annual premium rate increases.
The Empire Plan and HMOs are reviewing claims paid for ineligible dependents and requesting refunds from the enrollees who claimed those dependents. Enrollees may be billed for claims paid on ineligible dependents going back to February 1, 2009.
