Webinar: Marketplace Appeals Process

In this Health Reform: Beyond the Basics webinar presented in partnership with the National Health Law Program (NHeLP) on March 24, 2016, Mara Youdelman, Managing Attorney of the NHeLP Washington, DC, office, and Tara Straw, Senior Health Policy Analyst at CBPP, provides information on marketplace appeals, detailing what decisions can be appealed, how to file an appeal, and ways to expedite the appeal process.

Presentation Slides

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Watch the Webinar

Marketplace Eligibility Appeals

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National Health Law Program (NHeLP)

General process for appealing eligibility determinations (video section, slides)


What Determinations Can Be Appealed

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Not all determinations can be appealed to the Federal Appeals Entity (FAE) (video section, slides)

Marketplace appeals (video section, slides)

  • When to appeal to the FAE or a State-Based Marketplace (SBM)
  • Appealing a SBM determination to the FAE
  • When a determination can be appealed (video section, slides)
  • Example: What can be appealed? (video section, slides)
  • Example: “Temporary” eligibility determination (video section, slides)


How to Request an Appeal

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Requesting a marketplace eligibility appeal (video section, slides)

  • Timeframes for requesting appeals

Process once appeal is received (video section, slides)

Authorized representatives for an appeal (video section, slides)

  • Role of navigators in the appeals process
  • Example: Authorized representative


Appeals Process and Implementing Eligibility Decision

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Stages of an appeal:

Expedited appeals (video section, slides)

  • Example: Expedited appeal

Eligibility appeals decision (video section, slides)

Contact information for help with appeals (video section, slides)

Key points to remember (video section, slides)



Additional Resources