Health Advocate: Due Process

Source: Sarah Somers and Kim Lewis, National Health Law Program, Health Advocate, Vol. 19, November 2013

While almost everyone has heard about the new opportunities that the Affordable Care Act (ACA) brings to millions of uninsured Americans to obtain health coverage, many are not aware of the rights and protections that the newly insured will have protecting
them against wrongful denials of coverage. These rights stem from the Fourteenth Amendment of the U.S. Constitution, which prohibits governmental deprivations of “life, liberty, or property, without due process of law.” These rights are well-established for Medicaid beneficiaries and applicants. Now, federal regulations explicitly extend these rights to individuals seeking insurance coverage and other benefits through the newly created Health Insurance Exchanges. This issue of the Health Advocate describes the due process requirements governing the Exchanges and changes made to Medicaid notice and hearing regulations intended to coordinate and align the Exchange and Medicaid requirements.