Detailed Information on the
Internal Revenue Service Health Care Tax Credit Administration Assessment

Work with other participating federal agencies to developing long term goals by 2011 that capture the program's success in providing access to the tax credit to potential beneficiaries. Spring 2008 Update: During FY 2008, the IRS continued to work with agencies and stakeholders, like the Department of Labor, State Workforce Agencies, State Departments of Insurance and Departments of Employment Services, the Pension Benefit Guarantee Corporation and numerous Unions, to improve access to the Health Coverage Tax Credit (HCTC) and with DOL to discuss ways to improve the receipt of potentially eligible participant data. As a result a high-level end-to-end process for eligible Trade Adjustment Assistance (TAA) beneficiaries was identified, a first step in developing a long-term strategy for improving access to the HCTC. The IRS also increased access to HCTC by expanding the number of states with State Qualified Plans (SQP). Most recently HCTC successfully worked with the Airline Pilots Association and the Hawaii State Insurance Department to establish the first qualified health plan in Hawaii. The SQP was established in May 2008, thereby reducing the number of states without an SQP to only six. Additionally, Wisconsin and Ohio recently established or expanded their SQPs and Ohio Department of Employment Services now accepts payments directly from the state, enabling participants to decrease out of pocket expense, receive the credit more quickly, and streamline their payment process. The IRS will continue to work to broaden health provider options for eligible individuals and their families, as well as work more closely with other agencies to identify joint long-term goals for improved access to the program.

Working with partner federal agencies to find ways to improve access to the tax credit for eligible workers. Spring 2008 Update: Although the reauthorization and expansion of the Trade Act (TAA) legislation governing the HCTC is still pending, the program has moved forward with their strategy to partner with selected federal agencies and third-parties to provide information about the credit through established outreach and communication networks. The IRS is renewing partnerships with other organizations who have responsibility for delivering information and education on behalf of the HCTC program. Renewal of partnerships has allowed the IRS to contact individuals earlier in the process and to provide more flexibility for the workers to meet their insurance needs. Additionally, the IRS continues to participate in numerous recurring stakeholder meetings to discuss/explore ways to further improve access to the credit. Once new Trade Act legislation is enacted, IRS and the appropriate agencies will continue to address ways to improve the HCTC process and develop a communication plan to convey the new provisions of the law to current and potential participants.

Continuing to focus on administrative changes to lower program costs and improve taxpayer service. Spring 2008 Update: With the reauthorization of TAA legislation still pending, implementation of some IRS improvement actions has been delayed. In the first two quarters of FY 2008, the IRS successfully implemented a number of system efficiencies and processes to improve service to HCTC taxpayers, like solutions to reduce the call handle time at the call center and automation of nearly 15,000 annual health plan premium changes that in the past, had to be input manually. The IRS also decreased the cost of distributing HCTC eligibility letters and initial program information, improved the HCTC Medicare notification and cancellation procedures, and simplified the labor-intensive re-registration process when participants make account changes. The IRS also performed a data scrub on inactive HCTC accounts, minimizing manual maintenance of these accounts, and eliminating unnecessary notifications to stakeholders regarding eligibility changes. HCTC will continue moving forward with improvement actions as the legislation is finalized.

Measure: Customer Satisfaction

Explanation:Percentage of customers overall satsfied with the HCTC Program.

Measure: Costs per Taxpayer Served

Explanation:HCTC costs divided by taxpayers receiving assistance from HCTC staff. Measure reflects costs decrease from the FY 2006 baseline.

Measure: Customer Service Representative (CSR) Level of Service (LOS)

Explanation:Success rate of taxpayers attempting to reach a service representative.

Measure: Sign-up Time

Explanation:The median number of days between the day the IRS sends program kits to potential recipients and the day recipients enroll and remit their first payments to the IRS.

Is the program purpose clear?

Explanation: The Trade Adjustment Assistance (TAA) Reform Act of 2002 created the Health Care Tax Credit (HCTC) to assist certain recipients of trade adjustment assistance (TAA) and Pension Benefit Guaranty Corporation pension beneficiaries who are aged 55-64 to receive affordable health care. The program provides an advanced, refundable tax credit for 65 percent of the cost of qualified insurance. The credit can also be provided when the individual's tax return is filed. The IRS administers specific components of this credit: enrollment, payment and compliance. The Department of Labor (DOL), state workforce agencies and the Pension Benefits Guaranty Corporation (PBGC) have responsibility for determining potentially eligible HCTC taxpayers. Note; this evaluation focuses on the administration of the program (efficiency and success in delivering the credit) rather than the tax policy purposes.

Evidence: HCTC was authorized by Public Law 107-210, the Trade Adjustment Assistance Act of 2002 which specifies HCTC's purpose and sets for eligibility criteria. Section 202 of the TAA adds section 7527 to the Internal Revenue Code assigning the Secretary of Treasury responsibility for making payments, on behalf of certified individuals, to providers of qualified health insurance. Section 202 also requires the Secretary of Labor and the PBGC to determine eligible recipients.

Does the program address a specific and existing problem, interest, or need?

Explanation: The credit was created to help displaced workers and retirees who have lost their jobs due to trade with countries who participate in free trade agreements (e.g., the North America Free Trade Agreement). The IRS estimates that approximately 250,000 individuals are eligible in any given month. The credit pays for 65% of the health insurance premiums for participating eligible workers. The IRS responsibility relating to HCTC is to ensure participating eligible taxpayers receive the credit to which they are entitled.

Evidence: The TAA defines the population of displaced workers eligible for assistance (see Public Law 107-210, section 113). There are currently more than 700,000 taxpayers who have been identified as potentially eligible based on determinations made by the Department of Labor, state workforce agencies and the PBGC. The IRS uses additional screens (e.g. the taxpayer is Medicare eligible or the taxpayer has lost Trade Adjustment Assistance Benefits) to reduce this number to approximately 250,000 in any given month.

Is the program designed so that it is not redundant or duplicative of any other Federal, state, local or private effort?

Explanation: The HCTC provides a health insurance subsidy which is unavailable from other federal, state or local governments for this population. The IRS depends on information it receives from the Department of Labor (DOL), the Pension Benefit Guaranty Corporation (PBGC) and State Workforce Agencies (SWAs) to identify potentially eligible taxpayers. The roles of these organizations in administering the HCTC complement each other, rather than overlap.

Evidence: The HCTC program provides a specific benefit to a specific group of taxpayers and is not available through any other Federal, State, local, or private means (see the TAA conference report for a description of current law and the HCTC (http://thomas.loc.gov/cgi-bin/cpquery/?dbname=cp107&sid=cp107IFPLj&refer=&r_n=hr624.107&item=&sel=TOC_608779&). While IRS is supported by PBCG, DOL, and state workforce agencies, their roles do not overlap with IRS' (see TAA P.L. 107-210, section 202 for each organization's role).

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: The HCTC has a low participation rate. One likely reason for this low take-up is the amount of time it takes for the names of potentially eligible taxpayers to reach the IRS and enroll. Another likely cause is the affordability of coverage to potential recipients. It is also possible that many of those identified as potentially eligible may ultimately be determined not to qualify. An alternative program design that addressed these issues would likely reach a higher proportion of potential beneficiaries. Because of the low take-up, the IRS redesigned its the HCTC program to reduce costs and improve efficiency.

Evidence: The PBGC and DOL have identified more than 700,000 taxpayers as potentially eligible for HCTC. IRS eligibility screening reduces this number to about 250,000. Yet, the average monthly participation has been between 17,000 and 22,000 individuals and is not trending up. Some taxpayers also claim the credit on their end of year tax form rather than use the advanced payment. In 2004, the only year where full data is available, just 27,000 different taxpayers either received the advanced credit at some point in the year and/or claimed it on their returns. GAO found in a 2004 study that the "health coverage may not be affordable both in terms of an individual's ability to pay the entire premium amount while waiting to receive the advance HCTC and the ability to pay the 35 percent share once payment starts" ("Simplified and More Timely Enrollment Process Could Increase Participation" GAO-04-1029, www.GAO.gov ). An IRS review of the current process for certifying potentially eligible taxpayers shows it can take as long as six months before these names reach the IRS.

Is the program design effectively targeted so that resources will address the program's purpose directly and will reach intended beneficiaries?

Explanation: Eligibility for HCTC is limited to taxpayers who are identified by PBGC and DOL. These agencies have an extensive process for certifying HCTC eligibility. The IRS has built steps into the HCTC enrollment process to attempt to ensure only eligible taxpayers receive the credit. The program design makes advanced credit payments directly to the insurance companies which eliminates the potential for recipients to divert the subsidy to other uses for recipients of the advanced credit. The IRS also conducts reviews of potentially erroneous HCTC payments or refunds to ensure they were correctly made. Finally, IRS audits some high risk payments to ensure eligibility.

Evidence: The eligibility determination processes used by PBGC and DOL are complex and involve numerous steps. Once the IRS receives the names of potentially eligible taxpayers, it conducts additional data checks for key eligibility criteria. These checks have eliminated major known causes of erroneous refunds and payments identified through IRS' examination and review processes. The IRS believes that it is addressing the threat of erroneous payments, however, the Inspector General for Tax Administration (TIGTA) reports that "IRS does not have a reliable and comprehensive measure of the accuracy of information provided by taxpayers in connection with their participation in this program." (#200510024).

Does the program have a limited number of specific long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: The IRS has two primary, long-term measures for administration of the HCTC program: cost per taxpayer served and customer satisfaction. However, while useful, these measures do not adequately capture the program's success in providing access the HCTC credit to potential beneficiaries.

Evidence: See the measures section for details on the IRS' two long term goals. Cost per taxpayer served compares taxpayers receiving information from HCTC to the cost of delivering the service. It includes all taxpayers interacting with the HCTC program, not just those who ultimately receive service. This would be a more useful measure if compared costs to the number of taxpayers receiving benefits or to the dollar level of benefits. Customer satisfaction is based on random surveys of taxpayers communicating with HCTC telephone operators.

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: HCTC has ambitious goals for its long term measures. However, its measures do not adequately track program success (see question 2.1).

Evidence: See the measures section for details on the IRS' two long term goals. The HCTC long-term goal is to reduce cost per taxpayer served by 10 percent by 2011. Reaching this goal will be very challenging since the IRS has already cut program costs by 50 percent in the last two years by redesigning HCTC administration -- modifying service levels, consolidating infrastructure and down-sizing staff. The long-term customer satisfaction goal is 94 percent of taxpayers satisfied or very satisfied with HCTC by 2011.

Does the program have a limited number of specific annual performance measures that can demonstrate progress toward achieving the program's long-term goals?

Explanation: The IRS uses several measures in addition to the two long term measures mentioned in question 2.1 (customer satisfaction and cost per taxpayer served). They include the level of telephone service (the percent of time calls are answered), and customer engagement (the time it takes IRS to sign up new recipients). However, customer engagement time is measured from the time that IRS contacts a potential recipient. It does not include the time taken by IRS program partners to identify potential recipients and provide their information to IRS. The IRS also has a number of diagnostic measures used for internal management purposes such as taxpayers accounts resolved. However, while useful, HCTC' annual measures do not adequately capture the program's success in providing access the HCTC credit to potential beneficiaries.

Evidence: See the measures section for details on the IRS' performance measures.

Does the program have baselines and ambitious targets for its annual measures?

Explanation: HCTC has ambitious targets for its annual measures. However, as noted in question 2.2, annual measures do not adequately capture the program's success in providing access the HCTC credit to potential beneficiaries.

Evidence: See the measures section for details on HCTC's annual targets. The level of service targets are well below the FY 2005 actual. However, because the program is operating with reduced resource levels beginning in FY 2006, the lower targets make sense and are ambitious. They are also consistent with levels of service for other IRS programs. HCTC targets steady improvements in its customer engagement targets.

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) commit to and work toward the annual and/or long-term goals of the program?

Explanation: The IRS works closely with other federal agencies, states, health plan administrators and private sector entities to administer the HCTC. However, it does not currently have shared or coordinated performance goals with its main partners, DOL and PBGC.

Evidence: The IRS depends on data provided by the PGBC, DOL and state workforce agencies to determine potentially eligible taxpayers. The IRS also works directly with the 43 States and the District of Columbia that have State Qualified Health Plans. It maintains ties to all health plans associated with participating taxpayers.

Are independent evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: The Tax Inspector General (IG) and the General Accountability Office (GAO) audited the IRS HCTC program in 2004, 2005 and 2006. The results have been used to implement business process improvements. IRS' internal Office of Program Evaluation and Risk Analysis (OPERA) also studied HCTC in 2005.

Evidence: Recent audits have focused on the HCTC enrollment process, how well HCTC claims were processed and the need for improved controls over advance payments. Tax IG audits (see http://www.treas.gov/tigta) have included "Financial Controls Over the Health Coverage Tax Credit Advance Payment Process Need to Be Enhanced" (Audit # 200510024 DRAFT), and "The Health Coverage Tax Credit Was Accurately Processed During the 2004 Filing Season" (Audit # 200440013). GAO audits have included (see www.gao.gov) "Simplified and More Timely Enrollment Process Could Increase Participation" GAO-04-1029 and "Most Workers in Five Layoffs Received Services, but Better Outreach Needed on New Benefits" (GAO-06-43). The Tax IG and GAO are expected to continue frequent enough audits of this program to keep program managers informed of problems.

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: Starting with the FY 2008 Budget, the IRS has explicitly linked performance measures for HCTC to its resource request as part of its performance budget. However, the IRS' budget structure does not provide information on the full cost of programs.

Evidence: See the IRS' FY 2008 Congressional Submission, HCTC tab for the IRS's integrated budget submission and annual performance plan. (http://www.treasury.gov/offices/management/budget/budget-documents/cj/ See also the performance measures section of this evaluation. The HCTC vendor's contract contains specific performance requirements. However, until FY 2008, the HCTC budget request did not make these goals explicit.

Has the program taken meaningful steps to correct its strategic planning deficiencies?

Explanation: HCTC has made solid progress in implementing this unique tax credit during 2003 and more recently in adjusting the program successfully to lower funding levels. In addition, HCTC has worked on developing performance measures, but it still does not have measures which adequately capture the program's success in providing access the HCTC credit to potential beneficiaries. It also needs to work to harmonize its measures with program partners and to ensure budget materials reflect full program costs.

Evidence: See questions 2.1 through 2.7 for a discussion of HCTC's strategic planning issues. HCTC resources have fallen from $40 million in FY 2005 to $15 million in the FY 2008 request. The program was enacted in 2002 and came into operation late in 2003.

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation: The IRS collects HCTC performance information on a daily basis including receipts, production, inventories, and timeliness information. While the program lacks performance measures to adequately capture the program's success in providing access the HCTC credit to potential beneficiaries, its measures do provide useful diagnostic information to management. Program managers and IRS business partners meet daily using the information to quickly react to changes and address deficiencies. Data exchanges with FMS, PBGC and state Health Plan Administrators occur regularly.

Evidence: Examples of changes made based on performance information include revisions to HCTC operating model, changes to the technical architecture that supports the program, and modifications to the program's application and informational materials. The IRS is currently using performance data to develop an improved costing model for HCTC.

Are Federal managers and program partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) held accountable for cost, schedule and performance results?

Explanation: IRS managers have formal commitments associated with specific program results in their annual performance plans, making them accountable for their performance. Work plans are prepared with management input. IRS manager's performance is linked to pay and performance. The contractor providing much of the IRS' HCTC administration conducts a quarterly quality assurance assessment and is held accountable for scope, costs, schedule and quality.

Evidence: Examples of manager's commitments include: "I will balance improving administrative measures designed to reduce Health Coverage Tax Credits errors with IRS efforts to comply with the Improper Payments Information Act (IPIA)." "I will identify and implement a cost effective solution to addressing HCTC erroneous payments." The HCTC contract specifies numerous performance goals including standards for level of service and various components of the customer accounts resolution process.

Are funds (Federal and partners') obligated in a timely manner, spent for the intended purpose and accurately reported?

Explanation: HCTC obligates its resources consistent with its financial plans. When HCTC was created in FY 2003, the IRS had no experience with this type of credit and no clear understanding of likely program costs. As a result, more funding than ultimately was needed was provided for this account. HCTC managers limited spending levels to necessary expenses and allowed the balance of the funding to return to the general fund. In addition, HCTC budget needs dropped significantly when it adopted a new services operating model. This change freed up nearly $20 million that ultimately was returned to the general fund in FY 2005. HCTC has reduced its budget request in subsequent years to reflect this lower overall level of spending. This question has been given a lower weight than other questions in this section because HCTC is an annual largely salaries and expenses account. This type of account does not typically have problems with obligating resources according to plans.

Evidence: HCTC's received $35 million in 2005, $20 million in 2006, and has requested $15 million for 2007. IRS Financial System Reports enable the HCTC program to monitor spending against plan each month. In addition, TIPSS - Monthly Contract Reports enable IRS managers to monitor vendor expenses against plan.

Does the program have procedures (e.g. competitive sourcing/cost comparisons, IT improvements, appropriate incentives) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: As part of the strategic planning and management process, the HCTC program constantly reviews the existing operating model for savings opportunities. It has introduced a new efficiency measure, "cost per customer served," and its current vendor is contractually required to meet certain performance targets. The HCTC program develops a business case prior to investing in any process or technology improvements and tracks the outcomes of the initiatives against the original business case through a variety of diagnostic and performance measures.

Evidence: Current HCTC improvement projects include an erroneous payment review, a study of the current IRS compliance enforcement treatment of HCTC cases, and a set of modifications to ensure compliance with technology security requirements. Contractor performance targets include standards for level of service and various components of the customer accounts resolution process.

Does the program collaborate and coordinate effectively with related programs?

Explanation: DOL, PBGC and IRS have developed a multi-agency working group that continuously reviews interactions among the various components of the HCTC program, addresses problems as they arise, and seeks improvements in customer service. However, the three agencies have not yet set coordinated performance goals.

Evidence: DOL, PBGC and IRS work together to deliver the HCTC benefit, but have not yet developed coordinated performance goals. The HCTC working group meets bi-monthly to address common concerns and issues. Recent agenda items included: status of system and process improvements, GAO recommendations and data quality issues. HCTC works with state departments of insurance and health plans to help them understand HCTC processes, operations and requirements.

Does the program use strong financial management practices?

Explanation: The HCTC program follows sound financial management practices and none of IRS' material weaknesses relate directly to Employee Plans. IRS' auditor, the General Accountability Office (GAO), has given IRS a clean audit opinion and credit for improvements in its financial management. However, GAO still reports that; "The lack of a sound financial management system that can produce timely, accurate, and useful information needed for day-to-day decisions continues to present a serious challenge to IRS management."

Evidence: See Highlights of GAO-06-137 "IRS's Fiscal Years 2005 and 2004 Financial Statements" (www.gao.gov). GAO also reports, "IRS has continued to make great strides in addressing its financial management challenges and has substantially mitigated several material weaknesses in its internal controls. In FY 2005, IRS successfully implemented the first phase, or release, of its new Integrated Financial System (IFS), which is intended to replace the outdated financial management systems IRS used in recent years to process and report administrative (nontax) transactions. This first phase of IFS provides for improved audit trails and more timely information for such activities and transactions as travel, purchases of goods and services, and budgetary activities." A 2005 review by IRS' Office of Program Evaluation and Risk Analysis of the HCTC payment processing system found that the program controls comply with federal accounting standards. The review shows that deposits and payments are being correctly processed and that internal accounting and data controls are adequate.

Has the program taken meaningful steps to address its management deficiencies?

Explanation: HCTC uses long term planning, annual budget and performance planning and regular performance reviews throughout the year to identify and address management deficiencies. Program managers continually monitor performance information during peak tax return processing to ensure problems are identified and addressed quickly. Performance Reviews take place at all levels of the organization and take into account feedback from external parties such as TIGTA. While the program needs to coordinate better with partners on performance goals and suffers from IRS-wide financial management weaknesses, on the balance it has acted effectively to improve management.

Evidence: One example of HCTC's improvement efforts is to reduce the number of servers supporting program operations by 20%. HCTC uses monthly program reviews to ensure accountability for costs, schedules and performance results.

Has the program demonstrated adequate progress in achieving its long-term performance goals?

Explanation: HCTC has made solid progress in implementing this unique tax credit during 2003 and more recently in adjusting the program successfully to lower funding levels. However, its long term measures do not adequately capture the program's success in providing access the HCTC credit to potential beneficiaries.

Evidence: In FY 2006, customer satisfaction was 90 percent, equal to the long term target of 90 percent. IRS used FY 2006 to develop a baseline for its cost per taxpayer served goal. In 2004, the only year where full data is available, just 27,000 different taxpayers either received the advanced credit at some point in the year and/or claimed it on their returns. IRS estimates that roughly 250,000 taxpayers are eligible at any given point in time.

Does the program (including program partners) achieve its annual performance goals?

Explanation: While useful, HCTC' annual measures do not adequately capture the program's success in providing access the HCTC credit to potential beneficiaries.

Evidence: See the measures tab for specific information on HCTC's goals and actuals.

Does the program demonstrate improved efficiencies or cost effectiveness in achieving program goals each year?

Explanation: HCTC's efficiency measure is too new to demonstrate improved efficiency. However, the program has implemented a new service delivery model that enabled it to realize substantial annual cost savings (approximately $20 million) while continuing to provide the credit to approximately the same number of beneficiaries.

Evidence: The HCTC service delivery model included new reduced performance targets for key program components such as telephone level of service. This allowed the program to cut program operating costs by 50 percent. HCTC resources have fallen from $35 million in FY 2005 to $15 million in FY 2007 while average monthly beneficiaries has gone from 14,479 in FY 2005 to 15,886 in FY 2006.

Does the performance of this program compare favorably to other programs, including government, private, etc., with similar purpose and goals?

Explanation: No comparable federal, state, local government or private sector program exists.

Evidence: While there are similarities among in some aspects of HCTC and other tax credits (e.g. the earned income tax credit) there are also fundamental differences in the type of benefit and the target population that make it impossible to compare these programs.

Do independent evaluations of sufficient scope and quality indicate that the program is effective and achieving results?

Explanation: In 2005, the IRS' Office of Program Evaluation and Risk Analysis reported that the HCTC program office has done a "commendable job considering that the Program was established only two years ago." GAO and TIGTA have also acknowledged some success but found low participation, low knowledge of the program among potential recipients, a need for timelier and simplified enrollment, the need for improvements in controls over receivables, and the need for improved compliance information.

Evidence: In "Most Workers in Five Layoffs Received Services, but Better Outreach Needed on New Benefits" (Highlights of GAO-06-43), GAO found that "at four of five sites, fewer than half the workers who visited a one-stop center were aware of" the health insurance benefit. In "Simplified and More Timely Enrollment Process Could Increase Participation" GAO-04-1029, GAO recommended "that IRS, in coordination with other federal agencies, take steps to improve the quality and clarity of enrollment information and the timeliness of enrollment and payment processing." In "Financial Controls Over the Health Coverage Tax Credit (HCTC) Advance Payment Process Need to Be Enhanced" (Report #2006-10-085) TIGTA reported that "Generally, adequate procedures and controls have been established to ensure HCTC advance payment amounts are accurate." However, they also reported that improvements are needed in the control over receivables, the clarity of information provided to taxpayers and information on compliance.