Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: March 23, 2016

Program Area: Enrollment and Eligibility (ENR)

Question: An individual submitted an application through the Federally-facilitated Marketplace (FFM) and received the Eligibility results on April 15, 2015, stating that her children may be eligible for Health Connections (South Carolina's Medicaid). The client was informed that she would receive a final decision. However, after 10 weeks, the client's children are still without health insurance coverage. The client has contacted the state Medicaid office on several occasions, but no one is able to locate the application; the children's information; or verify the status of the children's eligibility. Please provide guidance on whether or not the client can make a change to her Health Insurance Marketplace application stating that the children were denied eligibility, so that they can get health insurance coverage while the state Medicaid office can figure out what is going on?

Answer: The individual may choose to appeal if she believes the eligibility results to be wrong. The individual should go to https://www.healthcare.gov/can-i-appeal-a-marketplace-decision/ to find and complete the appeal request form for her state. It should then be mailed to: Health Insurance Marketplace, 465 Industrial Blvd. ,London, KY 40750-0061.

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