Source: http://www.annalsofhealthlaw.com/annalsofhealthlaw/vol__24_issue_1?pg=120
Timestamp: 2019-04-25 08:34:32+00:00

Document:
without undue delay.”207 The Marketplaces, like Medicaid agencies, must also include the notice of the right to appeal and instructions on how to file an appeal in any eligibility determination notice issued to the applicant.208 Similar to Medicaid, the Marketplace regulations provide a right to appeal (1) determinations of the premium tax credit and cost sharing amounts, (2) determinations of exemptions from the individual mandate, and (3) failure to provide timely notice of an eligibility determination,209 including rights to expedited appeals and an informal resolution process.210 Marketplace appeals must be accessible to people with disabilities and individuals with limited English proficiency.211 Finally, like Medicaid, the regulations governing the Marketplaces include the right to continuing coverage pending appeal.212 However, as explained below, under current doctrine HHS does not have the authority to make these Marketplace rights privately enforceable, as they are in Medicaid. Without private enforcement, individuals who face delays and improper denials of coverage will have no recourse.
207. 45 C.F.R. § 155.310(e) (2014).
208. 45 C.F.R. § 155.355 (2014).
209. Compare 42 U.S. C. A. § 1396a(a)(3); 42 C.F.R. §§ 431.200–.250 (2014) ( Medicaid Protections) with 45 C.F.R. §§ 155.505–.555 (2014) (Marketplace Protections).
210. Compare 42 U.S. C. A. § 1396a(a)(3); 42 C.F.R. §§ 431.200–.250 (2014) ( Medicaid Protections); 45 C.F.R. §§ 155.505–.555 (2014) (Marketplace Protections) with.45 C.F.R. §§ 155.535, 155.540(a).
211. 45 C.F.R. § 155.505(f) (2014).
212. 45 C.F.R. § 155.525 (2014).
214. Sabrina Corlette, It’s Enough to Make You Loopy: Inside the Kafka-esque World of Medical “Loopers”, CTR. ON HEALTH INS. REFORMS (Apr. 27, 2014), http://chirblog.org/its-enough-to-make-you-loopy-inside-the-kafkaesque-world-of-medicaid-loopers/.

References: § 155
 § 155
 § 1396
 § 1396
 § 155
 § 155