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Appeals Archive

As part of our commitment to transparency, we make MNsure appeals decisions available to the public in this appeals archive.

Results 1 - 10 of 200
Date: October 05, 2018
Docket: 211645
The issue raised in this appeal is: Whether the agency properly determined the termination date of the appellant’s qualified health plan (QHP) as July 31, 2018. Recommended Decision: To affirm the agency’s decision to terminate the appellant’s QHP as of July 31, 2018. PROCEDURAL HISTORY 1. On July 23, 2018, the appellant filed an appeal regarding the termination date of her QHP. Exhibit #2. 2. On August 15, 2018, the human services judge held an evidentiary hearing on the matter by telephone. On April 15, 2018, the record closed consisting of the hearing testimony and four exhibits. 2
Date: August 23, 2018
Docket: 211006
The issue raised in this appeal is: Whether the agency properly determined that the appellants did not qualify for a Special Enrollment Period because they did not enroll in a qualified health plan (QHP) within 60 days after their qualifying life event. Recommended Decision: To REVERSE the agency’s decision that the appellants were not eligible for a Special Enrollment Period. PROCEDURAL HISTORY 1. On May 1, 2018, the appellants’ representative filed an appeal because they were no longer eligible for medical assistance (MA) and the agency would not let them enroll in a QHP. Exhibit # 2. 2. The agency determined that the appellants were not eligible for a Special Enrollment Period because they did not enroll in a QHP within 60 days after their qualifying life event which was losing MA. Exhibit #1. 3. On August 1, 2018, the human services judge held an evidentiary hearing on the matter by telephone. The record closed at the end of the hearing consisting of the hearing testimony and five exhibits. 2
Date: August 16, 2018
Docket: 208413
The issue(s) raised in this appeal is/are: Whether MNsure correctly determined that the Appellant was not eligible for retroactive termination of QHP coverage and correctly terminated the coverage effective July 31, 2018. Recommended Decision: The Agency determinations were correct and must be AFFIRMED. PROCEDURAL HISTORY 1. On July 18, 2018, the Appellant requested QHP coverage termination retroactive to July 1, 2018. Exhibit 1. 2. On July 18, 2018, MNsure (herein Agency) terminated the QHP coverage effective July 31, 2018. Exhibit 1. 3. On July 18, 2018, the Appellant filed an appeal. Exhibit 2. 4. On August 9, 2018, Human Services Judge Cimafranca held an evidentiary hearing on the matter by telephone conference. The record closed at the conclusion of the hearing consisting of two exhibits (Appeals Memorandum and attachments, Exhibit 1; Appeal Request, Exhibit 2).
Date: August 13, 2018
Docket: 210859
The issue(s) raised in this appeal is/are: Whether MNsure correctly determined that the Appellant was not eligible for retroactive termination of QHP coverage and correctly terminated the coverage effective June 30, 2018. Recommended Decision: The Agency determination was correct and must be AFFIRMED. PROCEDURAL HISTORY 1. On June 12, 2018, the Appellant requested QHP coverage termination retroactive to April 30, 2018. Exhibit 1. 2. On June 12, 2018, MNsure (herein Agency) terminated the QHP coverage effective June 30, 2018. Exhibit 1. 3. On June 14, 2018 the Appellant filed an appeal. Exhibit 1. 4. After one continuance at the request of the Appellant, on August 3, 2018, Human Services Judge Cimafranca held an evidentiary hearing on the matter by telephone conference. The record closed at the conclusion of the hearing consisting of two exhibits (Appeals Memorandum and attachments, Exhibit 1; Letters from the Appellant, Exhibit 2).
Date: August 09, 2018
Docket: 209772
The issue(s) raised in this appeal is/are: Whether MNsure correctly determined that the Appellant was not eligible for retroactive termination of QHP coverage and correctly terminated the coverage effective June 30, 2018. Recommended Decision: The Agency determination was correct and must be AFFIRMED. PROCEDURAL HISTORY 1. On June 19, 2018, the Appellant requested QHP coverage termination retroactive to June 1, 2018. Exhibit 1. 2. On June 19, 2018, MNsure (herein Agency) terminated the QHP coverage effective June 30, 2018. Exhibit 1. 3. On June 28, 2018 the Appellant filed an appeal. Exhibit 2. 4. On July 30, 2018, Human Services Judge Cimafranca held an evidentiary hearing on the matter by telephone conference. The record closed at the conclusion of the hearing consisting of two exhibits (Appeals Memorandum and attachments, Exhibit 1; Letters from the Appellant, Exhibit 2).
Date: August 03, 2018
Docket: 210267
The issues raised in this appeal are: 1. Whether the agency properly determined the termination date of the appellant’s qualified health plan (QHP) as June 30, 2018. 2. Whether the agency properly terminated the appellant’s advanced premium tax credits (APTS) as of June 1, 2018. Recommended Decision: 1. To affirm the agency’s decision to terminate the appellant’s QHP as of June 30, 2018. 2. To order the agency to notify UCare that the appellant was eligible for the APTC for June, 2018 so the appellant does not owe UCare $295.78. PROCEDURAL HISTORY 1. On June 26, 2018, the appellant filed an appeal regarding the termination date of his QHP and termination of his APTC for his QHP. Exhibit #2. 2. On July 26, 2018, the human services judge held an evidentiary hearing on the matter by telephone. The record was held open for additional information from the appellant. On August 1, 2018, the record closed consisting of the hearing testimony and seven exhibits. 2
Date: August 02, 2018
Docket: 210197
The issue raised in this appeal is: Whether the agency properly determined that the appellant did not qualify for a special enrollment period. Recommended Decision: To AFFIRM the agency’s decision that the appellant was not eligible for a special enrollment period. PROCEDURAL HISTORY 1. On June 18, 2018, the appellant filed an appeal because he was not able to enroll in any health care program. Exhibit # 2. 2. The agency determined that the appellant was not eligible for a special enrollment period because he did not have a qualifying life event. Exhibit #1. 3. On July 25, 2018, the human services judge held an evidentiary hearing on the matter by telephone. On July 25, 2018, the record closed consisting of the hearing testimony and three exhibits. 2
Date: August 01, 2018
Docket: 209842
The issue(s) raised in this appeal is/are: Whether the Agency correctly terminated the QHP coverage effective May 31, 2018. Recommended Decision: The Agency determination was incorrect. QHP coverage must be terminated effective May 23, 2018. PROCEDURAL HISTORY 1. On May 8, 2018, the Appellant contacted the Agency to request QHP coverage termination due to obtaining employer-sponsored coverage effective May 1, 2018. Exhibit 1. 2. On May 8, 2018, MNsure (herein Agency) terminated the QHP coverage effective May 31, 2018. Exhibit 1. 3. On May 10, 2018 the Appellant filed an appeal. Exhibit 2. 4. After one continuance for the benefit of the Appellant, on July 5, 2018, Human Services Judge Cimafranca held an evidentiary hearing on the matter by telephone conference. The record closed at the conclusion of the hearing consisting of two exhibits (Appeals Memorandum and attachments, Exhibit 1; Appeal Request, Exhibit 2).
Date: July 09, 2018
Docket: 208685
The issue raised in this appeal is: Whether MNsure (agency) properly determined that the appellant was not eligible for advance premium tax credits (APTC) for January, February, March, and April 2018 because he did not provide consent for the agency to have access to his Federal Tax Information (FTI). Recommended Decision: The human services judge recommends that the MNsure Board AFFIRM the agency’s decision that the appellant was eligible for APTC starting May 1, 2018 and was not eligible for APTC for January, February, March and April 2018. PROCEDURAL HISTORY 1. On October 5, 2017, the agency sent the appellant a Health Care Eligibility Renewal Notice informing the appellant that he and his wife, were approved for a qualified health plan (QHP) for January 1, 2018. It also said that they no longer qualified for APTC for January, 2018 because the agency could not tell if the appellant and his wife had filed a federal income tax return and they had not given consent to the agency to have access to their federal tax information. (FTI). Exhibit 1 . The appellant provided authorization to the agency to have access to their FIT on April 16, 2018. The agency determined that they were eligible for APTC starting May 1, 2018. On May 15, 2018 the appellant filed an appeal of the date when the APTC started. Exhibit 2. 2. On June 6, 2018, the human services judge held an evidentiary hearing on the matter by telephone. The record closed at the end of the hearing consisting of the hearing testimony and two exhibits. 2
Date: June 20, 2018
Docket: 208862
Disclaimer: As part of its commitment to transparency, MNsure makes publicly available this library of appeals decisions. Consistent with the requirements of applicable state and federal laws, protected information is removed from the decisions in this library. This library is not intended to give legal advice. You should not interpret these decisions as binding on anyone except the parties to the decision. The decisions are not precedent for any dispute between parties in the future. The laws affecting MNsure may change frequently and information provided in this library of decisions may not reflect the current state of the law. The decisions also may be subject to further review. Therefore, please consult with a knowledgeable expert before you take action in reliance on any information provided here.
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