Over 300,000 consumers who bought health insurance through the federal exchanges will receive a letter from the Department of Health and Human Services requesting documentation of citizenship or immigration status. (KAREN BLEIER/Agence France-Presse via Getty Images)

Federal health officials are warning hundreds of thousands of people who have bought health plans through the federal insurance exchange that their coverage will be cut off unless they quickly provide proof that their citizenship or immigration status makes them eligible to be insured through the new marketplace.

The warnings, in letters being mailed this week to 310,000 people in the three dozen states that rely on the exchange, give the recipients until Sept. 5 to send copies of green cards, citizenship documents or other information showing that they qualify for the coverage. If they miss the deadline, their coverage will end on Sept. 30.

This move is the first step the administration has taken to hold consumers accountable when information on their applications conflicts with records on file at federal agencies or is missing altogether.

The action, announced Tuesday, will affect only people with lingering eligibility issues involving their citizenship or immigration status. They are included in about 2 million cases of several kinds of application discrepancies involving people who have obtained coverage through the exchange.

Federal health officials said Tuesday that they will take separate action soon to resolve an even larger group of cases with discrepancies: those in which the income people listed on their insurance applications is out of sync with their federal tax records. In cases of unresolved income inconsistencies, the government could reduce — or eliminate — people’s federal insurance subsidies but could not end their coverage.

The number of warning notices generated state by state for citizenship, immigration status inconsistencies. (Department of Health and Human Services)

These steps are an effort by the administration to ensure, before the second insurance sign-up period through HealthCare.gov begins in the fall, that consumers who have such health plans are entitled to the coverage and the federal tax credits that are helping most of them pay for it.

Technical issues persist

The effort to iron out the differences also reflects the technical problems that have affected HealthCare.gov since the marketplace opened Oct. 1. These have included difficulties in the part of the online system designed to verify applicants’ identity, income and eligibility to buy a health plan.

The notice says in bold letters, “Act by September 5, 2014 or Your Marketplace Health Insurance May End.” It is being mailed less than two weeks after 150 organizations representing immigrants and low-income people nationwide appealed to Health and Human Services Secretary Sylvia Mathews Burwell to let people keep their coverage for now, regardless of whether their eligibility has been established.

In a July 31 letter , the organizations argued that many people whose eligibility remains in dispute have provided proof of their citizenship or immigration status, but their paperwork was caught in “system errors.” Other immigrants who still need to send documents, the organizations wrote, will be unable to understand the federal notices, which are being mailed only in English and Spanish.

Cutting off coverage “is what we were hoping to avoid,” said Jenny Rejeske, a health policy analyst at the National Immigration Law Center. “We don’t think it’s fair.”

Federal health officials said they have been working for two months to winnow the number of people with unresolved eligibility issues involving their citizenship and immigration status. As of late spring, after the first sign-up period in the federal marketplace, there were about 970,000 such cases. About 450,000 of them have been resolved, with no one ruled ineligible, said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, the HHS agency responsible for the federal insurance exchange.

Of the remaining cases, slightly more than 200,000 are “in process,” meaning that a federal contractor hired to verify eligibility, Serco, is comparing consumers’ documents with the records on file in federal agencies — or that people still are within the window set by federal rules to send in their documents.

The 310,000 who will receive the warnings have been asked by Serco to furnish documents, on average, five to seven times by phone, e-mail or mail, Albright said. Many of those people have never uploaded the necessary documents or sent them by mail, he said. But in an unknown number of cases, people sent the information but Serco has been unable to match it with the applications. “People will have to send in their info if we don’t have a record of it,” Albright said.

Immigrant groups worried

The 2010 Affordable Care Act, which created insurance marketplaces that began providing coverage in January, includes rules for who is eligible to buy a health plan and to receive new federal subsidies. The marketplaces are intended for people who cannot obtain affordable coverage through a job. In addition to U.S. citizens, the marketplaces are open to people who are lawful permanent residents, refugees, foreigners who have been granted asylum and people in a few other specific immigration categories.

Health policy specialists and advocates for immigrants said that federal officials must exclude unqualified people from the insurance exchange but that the timing of the letters and their potential effects are worrisome.

“You feel very different about someone not getting coverage because they couldn’t give documentation versus someone getting kicked off who’s had coverage for months,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, a health-policy organization. “That’s a function of how chaotic the systems and the enrollment process have been.”

Leonardo Cuello, the National Health Law Program’s director of health policy, praised HHS for having repeatedly tried to contact people with citizenship and immigration issues and for resolving nearly half of those cases in recent months. Still, he said, “it’s the ones being terminated you lose sleep over.”

Cuello said that some people don’t understand the notices, not realizing that documents they uploaded electronically or mailed months ago never arrived. Others have moved, did not receive previous notices and will not receive the new letter. And some speak languages other than English and Spanish and, with merely a tag ­line saying that help is available in their native language, will not understand the letter’s urgency, he said.

Rejeske, of the National Immigration Law Center, said some consumers could discover that their insurance has been canceled when they arrive at a doctor’s office.

“While we have concerns about this [HHS] step, we want people to gain coverage,” she said. “Our main message to consumers is . . . even if you’ve sent in documents, keep doing it until it works.”

In West Palm Beach, Fla., Vicky Tucci, who helps people sign up for the health plans at the Legal Aid Society, said she plans to turn to local radio stations for help with urging people to take the letters seriously. When earlier notices have arrived, relatively few people contacted her for help, she said, and some of them thought the notices were scams, because they had sent the proper documentation. In Florida, nearly 94,000 residents are being mailed the new letters, the most of any state, according to a federal breakdown of recipients.

In the Washington metropolitan area, nearly 14,000 Virginia residents will receive the letters. People will be unaffected in Maryland and the District, which have separate health insurance marketplaces.