All posts by Eric Thompson
In previous posts, I’ve explored the potential ramifications of the end of the Public Health Emergency (PHE) and how it will impact agency plans such as Medicaid eligibility redeterminations. Many states may have already prepared a risk-based approach to address the unwinding process. States need to balance these plans with onboarding new applicants and maintaining the service levels required by the Centers for Medicare & Medicaid Services (CMS). Regardless of the approach, states should look for efficiency in all aspects of the redeterminations process, including aligning pending work with other program recertifications and maximizing the use of available information and tools. What does the end of the PHE mean for state agencies? From the end of the PHE, state agencies will have 12 months to initiate all citizen eligibility renewals and a total of 14 months to complete them. States may begin the unwinding process 60 days prior to the month in which the PHE ends. Many states have already begun Medicaid eligibility redeterminations in an effort to meet this deadline. CMS has provided extensive guidance in their Planning for Resumption document, which state agencies can refer to for full details. Building a proper redeterminations plan Redeterminations plans should verify citizen information with all available information, including residency, age, income, and deceased status. These plans should also support the assessment of identity risk and have the ability to ensure continuous outreach with accurate mailing addresses, phone numbers for calls and texts, email addresses, and assessments of returned mail. CMS guidance encourages states to verify eligibility requirements by mail, email, and other communications channels while minimizing the amount of time and documentation required of beneficiaries. The benefit of standing up this structure? More effective day-forward solutions that can help agencies assess any new and ongoing benefits requests and maintain accurate eligibility lists. How can Experian help? Experian® has a range of products designed to help organizations verify contact information, such as phone numbers and mailing addresses, as well as income and employment. Our exclusive income and employment data can be leveraged incrementally in non-automated verification methods so that individuals not found by other services can be processed quickly via batch processing — minimizing any impact to beneficiaries while improving overall program performance. Our address verification tools provide improved outreach to beneficiaries with the best and most accurate mailing addresses, leveraging the National Change of Address (NCOA) database, as well as phone number information. The phone number information includes a mobile phone indicator, enabling text message outreach. Additionally, Experian can provide email address provisioning to verify or provide email addresses, which creates another path for contact. All of this helps agencies develop better redeterminations plans to manage the end of the PHE, and better process future benefits requests. To learn more about how we can help, visit us or request a call.
Earlier this year, I explored the potential impact of the end of the current Public Health Emergency (PHE). The U.S. federal government has been operating under a PHE for COVID-19 for more than 30 consecutive months since it was initially announced in January 2020. On July 15, 2022, this PHE was renewed for a tenth time. Following this latest extension, the Centers for Medicare & Medicaid Services (CMS) has released a roadmap for the end of the COVID-19 PHE. In a related blog, they reiterate the commitment to provide a 60-day notice prior to the end of the PHE, but urge states and healthcare providers to prepare for the end “as soon as possible.” With these upcoming changes in mind, I wanted to review key areas for providers to consider as they prepare for the end of the PHE. Enrollments continue to increase, putting state budgets at risk From the start of the PHE in February 2020 through April 2022, Medicaid/Children’s Health Insurance Plan (CHIP) enrollment has increased by more than 17M people and this is affecting every state. Nearly half of all states have experienced an increase of more than 25% during this time period, with some experiencing increases of more than 40%. Given an average Medicaid cost to states of more than $8.4K per capita, that translates to an increase of billions of dollars. Once the PHE expires, states will have 12 months to redetermine eligibility for continued enrollment in the program, or risk bearing 100% of the associated cost. Preparing for the end of the PHE To avoid unnecessary expenditures and ensure that citizens are receiving access to the correct services, states will have to conduct a holistic review of their Medicaid rolls to confirm eligibility. In CMS’s guidance for states to prepare for the end of the PHE, they recommend creating an automated process to handle this unprecedented review. With the right partner, agencies can perform redeterminations of their existing registration rolls, and prepare for future services requests. The right solution can allow citizens to easily apply for benefits, triggering the automatic, real-time pull of income and employment information so that the agency can verify eligibility. Experian is a trusted government partner that is ready to assist states with preparing and automating the process for redetermination of benefits. To learn more about how Experian can assist with citizen benefit redetermination and registration efforts, visit us or request a call. Learn more
Since January 27, 2020, the federal government has been operating under a Public Health Emergency (PHE) related to the COVID-19 pandemic. On January 14, 2022, this PHE was renewed for an eighth time. While we are currently in the midst of the omicron surge, some suggest that we may be nearing the beginning of the end of the pandemic — and thus the inevitable expiration of the PHE. Impacts of the PHE While the PHE remains in effect, states must maintain current Medicaid enrollees, regardless of changes to their eligibility status. A recent report showed Medicaid enrollment increased 16.8% from February 2020 to June 2021. This is counter to the previous trend, where enrollment declined from 2017 to 2019. Furthermore, the average per capita Medicaid cost to states is estimated at $5K–$10K (states share about one-third of the cost of Medicaid). The combination of the per capita expense and the increased number of enrollees during the pandemic translates to a significant impact on state budgets. Once the federal order expires, states will have 12 months to redetermine eligibility for continued enrollment in the program, or risk bearing 100% of the associated cost. Processing redetermination in a timely manner is critical for states to avoid unnecessary expenditures and to ensure that citizens are receiving access to the correct services. It’s imperative that states start planning for redetermination of benefits for continued Medicaid coverage as soon as possible to be prepared to take action at the inevitable conclusion of the PHE. Preparing for redeterminations At the end of the PHE, states will need a system to easily and confidently review their current Medicaid rolls to confirm eligibility. Implementing this system will likely involve working with a trusted partner who can provide tools and advantages such as: Portfolio analysis Real-time analysis Verification of income and employment Compliance adherence Affordability With the correct systems in place, states can act quickly once the PHE ends, saving unnecessary expenditures and providing better services to citizens in need. If your state agency would like to learn more about how Experian can assist with citizen benefit redetermination efforts, visit us or request a call. Learn more
The tax gap—the difference between what taxpayers should pay and what they actually pay on time—can have a substantial impact on states’ budgets. Tax agencies and other state departments are responsible for helping states manage their budgets by minimizing expected revenue shortfalls. Underreported income is a significant budget complication that continues to frustrate even the most effective tax agencies, until the right tools are brought into play. The Problem Underreporting is a large, complex issue for agencies. The IRS currently estimates the annual tax gap at $441 billion. There are multiple factors that comprise that total, but the most prevalent is underreporting, which represents 80% of the total tax gap. Of that, 54% is due to underreporting of individual income tax. In addition to being the largest contributor to the tax gap, underreporting is also extremely challenging to identify out of the millions of returns being filed. With 85% of taxes owed correctly reported and paid, finding underreporting can be like trying to locate a needle in the proverbial haystack. Making this even more challenging is the limited resources available for auditing returns, which makes efficiency key. The Solution Data, combined with artificial intelligence (AI) equals efficient detection. The problem with trying to detect which returns are most likely to have underreported income is similar to many other challenges Experian has solved with AI. Partnerships between Experian and state agencies combine what we know about consumers with what their agency knows about their population. We can take the data and use AI to separate the signal from the noise, finding opportunities to recoup lost revenue. Read our case study on how Experian was able to help an agency identify instances of underreporting, detecting an estimated $80 million annual lost revenue from underreported income. Download case study Contact us
Recently, I wrote about how Experian is assisting NASWA (National Association of State Workforce Agencies) with identity verification to help mitigate the spike in fraudulent unemployment insurance claims. Because of this I was not all that surprised when I found a letter in my mailbox from the Texas Workforce Commission with a fraudulent claim using my identity, inspiring me to follow up on this topic with a focus on fraud prevention best practices. Identity theft is on the rise According to Experian data analysis and a recent study on unemployment insurance fraud, at least 25% of new claims are a result of identity theft. This is 50 times higher than what we have traditionally seen in the highest ID theft fraud use case, new credit card applications, which generally amounts to less than 0.5% of new applications. Increasing digitization of the last few years—culminating in the huge leap forward in 2020—has resulted in a massive amount of information available online. Of that information, a reported 1.03 billion records were exposed between 2016 and 2020. There are currently approximately 330 million Americans, so on average more than three records per person have been exposed, creating an environment ripe for identity theft. In fact, a complete identity consisting of name, address, date of birth, and Social Security number (SSN) can be purchased for as little as $8. This stolen data is then often leveraged by both criminal rings who are able to perpetrate fraud on a large scale and smaller scale opportunists – like the ones in Riverside, CA leveraging access to identities of prison inmates. Fraud prevention through layered identity controls In the 20 years that I have been combatting ID theft both in the private and public sectors, I’ve learned that the most effective identity proofing goes beyond traditional identity resolution, validation, and verification. To be successful, you must take advantage of all available data and incorporate it into a layered and risk-based approach that utilizes device details, user behavior, biometrics, and more. Below, I outline three key layers to design an effective process for ID proofing new unemployment insurance claims. Layer 1: Resolve and Validate Identities Traditional identity data consists of the same basic information—name, address, date of birth, telephone number, and SSN—which is now readily available to fraudsters. These have been the foundation for ID proofing in the past and are still critical to resolving the identity in question. The key is to also include additional identity elements like email address and phone number to gain a more holistic view of the applicant. Layer 2: Assess Fraud Risk Determining an identity belongs to a real-life subject is not sufficient to mitigate the risk of ID theft associated with a new unemployment insurance claim. You must go beyond identity validation to assess the risk associated with their claim. Risk assessment risk falls into two categories – identity and digital risk. Identity Risk When assessing a claim, it’s important to check the identity for: Velocity: How often have you (or other states) seen the information being presented with this application? Has the information been associated with multiple identities? Recency of change: How long has the identity been associated with the contact information (phone, email, address, etc.)? Red flags: Has the subject been a recent victim of ID theft, or are they reported as deceased? Synthetic Identity: Are there signs that the identity itself is fictitious or manipulated and does not belong to a real-life person? Digital Risk Similar to the identity risk layer above, the device itself and how the subject interacts with the device are significantly important in identifying the likelihood a new claim is fraudulent. Device risk can be assessed by utilizing geolocation and checking for inconsistent settings or high-risk browsers, while behavioral risk might check for mouse movement, typing speed, or screen pressure. Layer 3: Verify Highest Risk Subjects The final stage in this process is to require additional verification for the highest risk claims, which helps to balance the experience of your valid subjects while minimizing the impact of fraud. Additional steps might include: Document verification: Scanning a government-issued ID (driver’s license, passport, or similar), which includes assessing for document security features and biometric comparison to the applicant. One-time passcode (OTP): It is key to deploy this sparingly only to phone numbers that have been associated with the subject for a significant time frame and incorporate checks to determine if it is at high risk (e.g., recently ported or forwarded). Knowledge-based verification (KBV): Leveraging non-public information from a variety of sources. By adding additional, context-based identity elements, it becomes possible to improve the three main objectives of most agencies’ identity proofing process – get good constituents through the first time, protect the agency and citizens from fraud, and deliver a smooth and secure customer experience in online channels. While there’s no quick fix to prevent unemployment insurance fraud, a layered identity strategy can help prevent it. Finding a partner that has a single, holistic solution empowers agencies to defend against unemployment insurance fraud while minimizing friction for the end-user, and preparing for future fraud schemes. To learn more about how you can protect your constituents and your agency from unemployment insurance fraud request a call today. Contact us
In the wake of unprecedented unemployment fraud since the start of COVID-19, Experian announced it was selected as the exclusive partner for identity and fraud verification for the Unemployment Insurance (UI) Integrity Center’s centralized Identity Verification (IDV) capability. IDV is available to state agencies at no cost through UI Integrity Center, which is operated by the National Association of Workforce Agencies (NASWA) in partnership with the U.S. Department of Labor. With the Federal Bureau of Investigations (FBI) reporting a spike in fraudulent unemployment insurance claims complaints related to COVID-19, it’s more important than ever for state agencies to use innovative solutions to verify identities that are applying for unemployment insurance to protect consumers. If improper unemployment insurance payments are made to fraudsters, the efforts of the CARES Act could be largely wasted. The IDV capability leverages Experian’s Precise IDTM to provide a centralized identity verification and proofing solution. Precise ID combines identity analytics with advanced fraud risk models to distinguish various types of fraud, which can help state agencies maximize time and resources. When state agencies submit claims, the IDV solution will return ID theft scoring and associated cause codes, enabling them to assess whether a claim may be fraudulent. “Due to the COVID-19 health crisis, unemployment is high, with over roughly 60 million Americans filing for unemployment since March,” said Robert Boxberger, president of Experian’s Decision Analytics in North America. “At Experian, we’re proud to have a strong culture dedicated to continuous innovation that helps protect consumers’ financial health. We’re taking that same consumer focus and helping make the unemployment insurance application process more efficient and safer for constituents.” The Integrity Data Hub (IDH) is a robust, multi-state data system that contains a continuously expanding set of sources to provide advanced cross-matching and analytic capabilities to states. It is designed to be easily implemented by any state Unemployment Insurance agency, regardless of claim volume, technology, or access to internal resources. The IDH was designed and built using the latest National Institute of Standards and Technology IT security standards, including the use of asymmetric encryption and other techniques to ensure the security of sensitive data. “We’re excited to partner with Experian and utilize its Precise ID solution to assist states in mitigating fraud during these unprecedented times,” said Scott Sanders, NASWA Executive Director. “States are finding this to be a very valuable tool and we are pleased that we can offer this solution to states through our partnership with the U.S. Department of Labor.” Read Press Release Learn More About Precise ID