Vol. 24 Annals of Health Law 365
Marketplaces to the state Medicaid agencies was not running when the federal Marketplace website was launched, and the data the federal government was able to send to the states often had missing or incorrect infor-
mation.215 These types of errors, delays, and improper denials have often
been challenged in Medicaid litigation, because delays and lost applications
implicate the ability to exercise appeal rights or quickly request an informal
hearing.216 These barriers are particularly troublesome for individuals who
might be eligible for Medicaid. When a Marketplace finds someone eligible
for premium tax credits, it is necessarily making a judgment that the individual is ineligible for Medicaid because if their income is high enough for
premium tax credits, it is too high for Medicaid.217 The converse is also
true: an individual found eligible for Medicaid is also being denied tax
credits.218 However, it is not clear that the Marketplaces are providing proper notice to individuals who are found eligible for one program that they are
also ineligible for the other and are entitled to appeal that determination.219
Furthermore, there are reports that some of the initial eligibility assessments are simply wrong. Matt Salo, who runs the National Association of
Medicaid Directors, reported that often when the federal Marketplace sends
a file to the state Medicaid agencies, “[a] quick glance sometimes shows
215. Sarah Kliff, HealthCare.gov Is Having Trouble Signing People Up for Medicaid,
WASH. POST (Dec. 4, 2013), http://www.washingtonpost.com/blogs/wonkblog/wp
216. See e.g., Reynolds v. Guliani, No. 98 Civ.8877 (WHP), 2005 WL 342106
(S. D.N.Y. Feb. 14, 2005), (partially rev’d on other grounds, (challenging the failure for
New York City to process Medicaid, SNAP and TANF applications within statutory
timeframes and improperly deterring eligible applicants from applying); Shafer et al. v.
Bremby, No. 12-CV-00039 ( D. Conn. Jan. 9, 2012) (challenging long delays in processing
217. See Kaiser Family Foundation, The Coverage Gap: Uninsured Poor Adults in
States that Do Not Expand Medicaid (Apr. 2, 2014), http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.
(“The expansion was intended to be national and to be the vehicle for covering low-income
individuals, with premium tax credits for Marketplace coverage serving as the vehicle for
covering people with higher incomes.”). In states that expanded Medicaid “the expansion
extends Medicaid eligibility to all parents and other adults up to the new Medicaid limit. For
people with incomes above that limit, other provisions of the ACA—particularly the availability of premium tax credits to purchase individual coverage through the Health Insurance
Marketplaces—will facilitate access to affordable coverage.” Id.
218. For a description of how, in states that have not expanded Medicaid, an individual
might actually be ineligible for either Medicaid or tax subsidies on the Marketplaces. See id.
Because an individual cannot be eligible for both Medicaid and tax credits on the Market-placea determination of eligibility for one benefit is by definition a determination that the
individual is ineligible for the other program. Id.
219. See, e.g., Amy Goldstein, Healthcare.gov Can’t Handle Appeals of Enrollment
Errors, WASH. POST (Feb. 2, 2014), http://www.washingtonpost.com/national/health-