Due process enforcement is a common element across our litigation and policy advocacy because too often Medicaid enrollees’ coverage and services are threatened without the required processes that protect their access to critical services.
NHeLP’s due process litigation and policy advocacy has helped ensure Medicaid enrollee rights are not impacted by the use of managed care and that Medicaid coverage is not denied or ended without appropriate notice and access to a hearing. This is particularly important because managed care uses a more complicated appeal process that can be even more challenging for enrollees to navigate. Chronically low appeal rates for decisions on prior authorizations and other service denials from managed care plans demonstrate some of those challenges.
Our work in this area focuses on developing policies that make it easier for enrollees to know their health care rights, obtain information explaining decisions related to their needs and eligibility, and maintain access to the courts so people can enforce their health care rights and access the care they need.
