Lessons from CA: Exchange Eligibility Appeals under the Affordable Care

Lessons from CA: Exchange Eligibility Appeals under the Affordable Care

Executive Summary

Section 1411(f) of the Affordable Care Act requires the HHS Secretary to establish an appeals process related to eligibility determinations made by Exchanges, including among other things, eligibility for enrollment in a QHP and eligibility for premium tax credits and cost-sharing reductions. The federal Department of Health & Human Services (HHS) published final rules on August 30, 2013 that address the notice and hearing requirements for these eligibility appeals as well as obligations of the Exchange appeals entities who hears these appeals (and the relationship between Exchange appeals and Medicaid/CHIP appeals).

Related Content

For almost 50 years, the National Health Law Program has fought to expand access to quality health care to low-income individuals and underserved communities. Today we are pleased to launch a newly designed website for our future work to make health care a reality for all people. Please take time to peruse our new site, and sign up for our email updates to learn about us, watch the work we do, and become engaged.

Continue to site