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. The volume of appeals is beyond the health care appeals team (HCAT)’s control since appeals requests come from members. 

As of SFY22 subsidy eligibility and coverage dates were added to the categories list to report on to get a better picture of the appealed issues.

As of January 2022, we stopped tracking the Premium related appeals as these have transitioned to the carrier since the carriers started processing premium payments.

Narrative last updated:  02/15/22

• Office of the Attorney General
• DVHA Health Access Eligibility & Enrollment Unit