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Obamacare Appeals Getting Heard In Connecticut

by Christine Stuart | Feb 25, 2014 12:45pm
(1) Comment | Commenting has expired
Posted to: Health Care

Christine Stuart file photo

Department of Social Services Commissioner Roderick Bremby. He used to work under HHS Secretary Kathleen Sebelius in Kansas

The federal government has had trouble dealing with the tens of thousands of people who had difficulties signing up for plans under the Affordable Care Act, but Connecticut consumers have been swiftly making their way through an appeals process, according to state officials.

Since the Oct. 1 launch of Access Health CT, Connecticut’s insurance exchange, there have been 470 appeals filed by individuals who, for a variety of reasons, were unable to obtain coverage or were not able to get the appropriate premium tax subsidy applied to the plan they bought.

That’s compared to the 22,000 filed by Americans from the 36 states using Healthcare.gov. A Washington Post article from earlier this month says those appeals are sitting untouched in a government computer that no one was able to access. A spokeswoman for the Centers for Medicare and Medicaid Services later told the paper that they were working on the problem and coming up with an appeals process. White House spokesman Jay Carney has said many of the appeals were resolved after problems with the website were fixed.

The website problems and the latest appeals process are problems Connecticut didn’t have, according to state officials in charge of the program.

“As with other aspects of the Affordable Care Act, Connecticut has moved swiftly to begin to ensure the due process rights guaranteed for applicants under the law,” Department of Social Services Commissioner Roderick Bremby said.

Of the 470 appeals filed in Connecticut, about 330 were resolved without a hearing. There have been 26 hearings held, and 114 hearings have been scheduled.

While they have been unable to share specific information about the appeals, state officials said that in general they include Medicaid denials based on excess income, application of the wrong premium tax subsidy, effective dates for coverage, and filing status issues with the Internal Revenue Services.

The appeals are being handled by the Department of Social Services Legal Counsel, Administrative Hearings, and Regulations.

The staff are helping to resolve the great majority of requests before they go to hearing, which is effective for both applicants and the programs, Bremby said this week. Hearing officers have begun to conduct hearings when resolution is not possible, with others scheduled over the coming weeks.

Of the 26 hearings that have been held, decisions have been rendered in 16 of the cases.

“We believe this joint process between DSS and Access Health CT will work well in balancing applicant rights with program eligibility criteria and access under the new law,” Bremby added.

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posted by: lkulmann | February 26, 2014  6:28pm

It would be interesting to see if other states send legal issues concerning insurance to a social services department when we have a state insurance agency. It would make sense to consolidate that set-up.