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FORT MYERS, Fla. — Nearly 94,000 Floridians must prove their citizenship and immigration status by the first week of September or lose the health insurance they bought through the Affordable Care Act.

The Federal Health Insurance Marketplace began sending out notices this week in English and Spanish to policyholders with what it called inconsistencies in their citizenship records. These people, who have been previously unreachable via mail, e-mail or phone, have until Sept. 5 to submit the needed paperwork. If they don't they will lose coverage Sept. 30.

Florida has the largest number of the nation's 310,000 questionable policies obtained on the federal insurance exchange — 93,800 as of Sunday, according to the Centers for Medicare and Medicaid Services. Texas has 52,700 such cases, and Georgia has 20,900.

By contrast, North Dakota, South Dakota and Wyoming have 300 cases.

Federal officials said they already have closed out 450,000 other citizen and immigration cases, and another 210,000 are under review.

"We want as many consumers as possible to remain enrolled in Marketplace coverage, so we are giving these individuals a last chance to submit their documents before their coverage through the Marketplace will end," Administrator Marilyn Tavenner of the Centers for Medicare and Medicaid Services said in a statement Tuesday.

The information released Tuesday do not show which parts of the states had the biggest problems.

Ed Houck, president of the Health Planning Council of Southwest Florida, which supervised much of the Obamacare sign-up efforts in the region, said he was unaware of the issue. Sign-up navigators asked enrollees they assisted to provide proof of citizenship.

"That's part of the training," Houck said.

Federal officials said they have reached out multiple times to policyholders with questionable sign-up information. Those with information still under review or whose policies have been verified will not get a notice.

This doesn't mean these applicants are in the United States illegally. But it can mean that a Social Security or Permanent Resident number the applicant used was incompletely entered into the system or does not match government records, federal officials said.

Sylvia Delgado, a social worker and insurance application counselor in Cape Coral, Fla., said she believes most of these questionable cases are the result of data-entry glitches.

"We don't think there is going to be a problem where all of these numbers (of questionable applications) coming up are going to be ineligible," she said.

Nearly 1 million Floridians signed up for health plans under the Affordable Care Act, more than twice the number that government officials had predicted.

That potentially a 10th of them are problem applications came as a surprise to Roger Ward, chief operating officer at Family Health Centers of Southwest Florida. Family Health Centers, which offers primary medical and dental services, took a leading role in the sign-up effort here.

"That's a big number when you think about it for Florida," Ward said.

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