With tax day less than two weeks away, more than 200 Vermonters are still waiting on paperwork from Vermont Health Connect that serves as proof of their health coverage under the Affordable Care Act.
Kathryn Nicoli is one of those Vermonters. She works a lot.
"I work seven days a week, about 104 hours a week, nine to 12," she says. "I worked back-to-back shifts every Friday, Saturday, and Sunday, and that's a day rate; when I work 24-hour shifts it is $153.60 now. So I do that to try to make up for the $12-dollar-an-hours."
She's doing math often to make sure she's making enough to cover her expenses, but this year when she did her taxes, the numbers didn't add up.
For Nicoli, who says she basically lives check-to-check, the problem could add hundreds of dollars to her tax bill.
She says she signed up for health coverage on Vermont Health Connect last May, but for her, the plan didn't cut it.
"With the insurance that I had, a copay on one of my medications was roughly $230 a month, and I said I can't do this," she says. "I can't pay $200 for insurance and pay $230 a month for one medication while I do."
Nicoli used to be a Marine, so she went to the VA and found out that she qualified for need-based health care.
"I was told when I exited the exchange Sept. 30: 'Well you'll probably continue to get bills. Just ignore them because it takes a while for the system to catch up.'" — Kathryn Nicoli
She says she called Vermont Health Connect Sept. 15, 2015, to cancel her coverage, and they told her the coverage would stop at the end of the month.
"I was told when I exited the exchange Sept. 30: 'Well you'll probably continue to get bills. Just ignore them because it takes a while for the system to catch up,'" she recalls.
Well, she did get another bill, and Nicoli says she even called Vermont Health Connect and they confirmed that she didn't need to pay and her coverage was terminated.
Fast forward to this February, when she got an important tax document in the mail from Vermont Health Connect, her 1095-A.
"And the reason why that form is so important is because on the form it shows the federal subsidies that you received to offset the cost of the insurance," she explains. "So on that form I received, I believe it was $228.40 a month in federal subsidies."
Nicoli ended up earning more than she'd expected, so the government is now asking her to pay back that subsidy money.
And she says she has no problem paying back the subsidy money she benefited from — she earned more than expected, so she had to pay back the money she ultimately wasn't entitled to. But the amount she owed was a surprise.
"I looked at it and realized, 'Oh, this isn't right. It shows me being in the health exchange for the month of October,'" she says.
The feds are expecting her to pay them back for $228 of subsidy money that she says she never received.
She called Vermont Health Connect, and she says they told her it was their fault and they'd send a new form.
That was February, and she still doesn't have a new copy. She says she kept calling and they kept telling her they'd send one right away.
And Nicoli's not alone.
Lawrence Miller, the head of the state's health care reform efforts, says there are 236 1095 forms that still need to be corrected and sent out. Miller says the state has already successfully sent out 1095 forms for more than 100,000 Vermonters, so the outstanding changes make up less than one half of one percent of the forms the state was responsible for sending.
He says the errors that made it onto the 1095 forms likely came before the state double-checked its numbers.
"We work through a year-end reconciliation process with the carriers," he says. "It's a process of making sure all the data is right in the VHC system, the premium processor, and the carriers, and clean up any errors or omissions at the end of the year."
Lawrence Miller, the head of the state's health care reform efforts, says there are 236 1095 forms that still need to be corrected and sent out.
For Nicoli, those errors and omissions could be costly.
The extra $228, she says, is the difference between a manageable tax bill and outright hardship.
With the tax deadline looming, Nicoli has to choose between waiting on a new form at the risk of tax penalties or paying back the October subsidy on health care she didn't receive.
Then this week, she got another call. She says Vermont Health Connect is now claiming that Nicoli was covered in October, and she does owe the money.
If she doesn't want to pay up, Nicoli says the state put the onus on her to prove her case.
"So at this point they're sending me a form to fill out that says I have to [say] why the phone conversations of September 15 and October 16 need to be pulled," she said. "They're going to pull those conversations to validate that what I told her today is, in fact, the truth."
In other words, she says, "they're putting the burden of proof on me."
Until she proves her point, she says the state is refusing to send her a new form.
Update 4:48 p.m. April 6, 2016 After VPR first reported this story, Miller looked up information about Nicoli's situation. In a follow-up call to VPR and with Nicoli's consent to share her information, Miller said that Vermont Health Connect had not made a mistake in her case.
Miller explained that regulations in place stipulate that changes made after the 15th of the month do not have to be implemented until the end of the following month.
Nicoli called Vermont Health Connect on Sept. 16, Miller said, which means the changes to her account wouldn’t have been effective until the end of October.
“VHC followed exactly the law in this case, and the correct termination date was October 31,” Miller said. “She got exactly what the law specified. She was treated properly. I know she didn’t like that outcome, but it was the correct outcome.”
Miller said the state is sending Nicoli a new 1095-A because she was properly covered in October, but that her frustrations were not the result of mistakes by Vermont Health Connect staff.
While there are 236 Vermonters waiting for 1035 forms from Vermont Health Connect, the state doesn’t count Nicoli as one of them.
Correction 11:38 a.m. April 6, 2016 An earlier version of this story incorrectly stated that Nicoli made less than she expected in 2015. The story has been corrected to reflect that she, in fact, made more than expected.
Update 7:30 p.m. The above text was updated to reflect comments from Lawrence Miller that more than 100,000 of the 1095 forms have been sent successfully.
