Appeals Unit and 1 more...
# of eligibility appeals received by category
Current Value
110
Definition
Notes on Methodology
| # of eligibility appeals received by category | Dec-25 | Jan-26 | Feb-26 | Mar-26 | Apr-26 | May-26 | Jun-26 |
| MAGI Medicaid | 76 | 46 | 34 | 54 | 49 | 46 | 41 |
| Non-MAGI Medicaid | 11 | 12 | 23 | 16 | 22 | 21 | 15 |
| Subsidy eligibility | 145 | 96 | 44 | 46 | 36 | 43 | 33 |
| Coverage dates | 5 | 16 | 27 | 25 | 31 | 7 | 7 |
| QHP - Premium Processing | |||||||
| QHP - No SEP | 0 | 2 | 8 | 12 | 5 | 7 | 7 |
| Other QHP | 5 | 8 | 8 | 7 | 5 | 12 | 7 |
| Total | 242 | 180 | 144 | 160 | 148 | 136 | 110 |
Story Behind the Curve
This performance measure is important because by tracking the number of eligibility appeals received during a month by category, this allows the Health Care Appeals Team (HCAT) to identify program wide trends.
We have identified the seven most common categories of appeals in the break out grid above.
The volume of appeals is beyond the health care appeals team (HCAT)’s control since appeals requests come from members.
Narrative last updated: 04/21/23
Partners
- Office of the Attorney General
- DVHA Health Access Eligibility & Enrollment Unit
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