On August 30, the U.S. Department of Health and Human Services published a
final rule on provisions related to exchange operations, including individual eligibility appeals processes.
To further delve into these finalized appeals regulations and their implications for exchanges, the
State Health Reform Assistance Network hosted a webinar on individual eligibility appeals. This webinar, led by Melinda Dutton and Kinda Serafi of Manatt Health Solutions, provided an overview of requirements put forth in the regulations, including:
- state options for delegation of MAGI Medicaid and Exchange appeals;
- the standards for components of the appeal process, such as for appeal notices, appeal requests, pended benefits, informal resolution, hearings, and appeal decisions;
- the due process and procedural rights of the appellant; and
- requirements for coordination between agencies and appeals entities.
The discussion also highlighted open policy and operational issues for the design of coordinated appeal processes. Ryan Lipinski of the Illinois Department of Healthcare and Family Services and Lindsay McAllister of the Rhode Island Office of the Lieutenant Governor joined the webinar to share their respective state’s approach to the individual eligibility appeals process.
The slide deck and a recording of the webinar are available
here.
