Final

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

Issue Date: November 21, 2013

Program Area: Enrollment and Eligibility (ENR)

Question: Will the FFM handle all eligibility appeals rather than the Issuers? If that is the case, what would the process be for eligibility appeals received by the Issuer?

Answer: Yes, in FFM states all eligibility appeals will be handled by HHS. If an issuer receives a misdirected eligibility appeal, they should inform the consumer that these appeals are handled by HHS and refer them to healthcare.gov or the call center for more information on how to request an eligibility appeal.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.