With the Patient Protection and Affordable Care Act’s (ACA’s) ninth open enrollment period (OEP) set to launch in less than a month, the ACA Marketplaces are seeing record enrollment numbers with more generous subsidies, new carrier competition, and a relatively stable rating environment. At the same time, there is uncertainty with the trajectory of the COVID-19 pandemic and medical costs trending upward as the economy recovers, albeit at an uneven pace. These trends have made for a challenging rate review process in the 47 states plus the District of Columbia (D.C.) that conduct their own ACA rate reviews of carrier-proposed rates using federal review standards. State announcements of 2022 rates have trickled out at a slower pace than in prior years, and it is likely that many states will not publish their approved rates until the beginning of open enrollment. As always, state rate results vary widely and, even within states, there often are substantial variations among carriers and across different regions in geographically diverse states. With these caveats, this expert perspective highlights some observations about the factors that are impacting rate changes this year and the kind of variations that exist among states.
Individual Eligibility Appeals Webinar
Melinda Dutton, Partner, Manatt Health Solutions Kinda Serafi, Counsel, Manatt Health Solutions
Introduction & Overview
The State Coverage Initiatives program, in coordination with the State Network, hosted a webinar on September 23, 2013 that discussed individual eligibility appeals. Melinda Dutton and Kinda Serafi from Manatt Health Solutions facilitated this webinar with state respondents from Illinois and Rhode Island. The webinar provided an overview of appeals 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 webinar slides can be found at the “download” button and a webinar recording can be found here.