366 Holding Health Insurance Marketplaces Accountable 2015
[the applicant is] not Medicaid eligible because they earn too much.”220
New Marketplaces that are still working out the kinks may provide inadequate or no notice of decisions, or will not have sufficient appeals proce-
dures.221 The Marketplace websites and printed information may not be
available in multiple languages, in violation of important language access
There are also likely to be disputes over the amount of the tax credits individuals are awarded.223 Advanced premium tax credits are based on predicting income for the upcoming year.224 However, because the Marketplace systems are also intended to assess an individual’s current Medicaid
eligibility, many of the questions are phrased in the present-tense, while
others are in the future-tense.225 This can cause tremendous confusion as
individuals fill out the applications online.226 Relying on a system where
people guess their own future income also introduces significant potential
risks of miscalculating eligibility for subsidies.227 The result will be a discrepancy between the amount of premium tax credits that people predicted
they would be eligible for and the amount that they are actually eligible
for.228 When people file taxes they will have to reconcile their tax credits,
which could mean a larger refund if an individual makes less money than
expected, or it could mean owing taxes.229
For those states using premium assistance for their Medicaid expansion
population, there may also be disputes over covered benefits.230 Private
220. Kliff, supra note 215.
221. See, e.g., Goldstein, supra note 219.
222. See Ctr. for Budget & Policy Priorities, Health Reform: Designing a Marketplace,
CBPP.ORG, http://apps.cbpp.org/DesigningAMarketplace/ (last visited Nov. 15, 2014) (
Connecticut, D. C. Massachusetts, and Minnesota only provide their website in English and do
not provide additional materials in other language. Several other states provide materials and
resources in other languages, but have not provided language access through the website).
223. See, Sandhya Somashekhar et. al, Federal Appeals Courts Issue Contradictory
Rulings on Health-Law Subsidies, WASH. POST (NOV. 10, 2014) http://www.
224. See 42 U.S. C. A. § 18082.
225. See, e.g., CTRS. FOR MEDICARE & MEDICAID SERVS., APPLICATION FOR HEALTH
COVERAGE & HELP PAYING COSTS, available at http://marketplace.cms.gov/applications-and-forms/marketplace-application-for-family.pdf.
226. For example, someone who is currently married, but seeking a divorce, might predict that they will file taxes as a “head of household” but would truthfully indicate they are
“currently married.” Id.
227. Julia James, Health Policy Brief: Premium Tax Credits, HEALTH AFFAIRS, 4-5,
(2013), available at http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief
228. See 26 U.S. C. A. § 36B(f) (West, WestlawNext through P.L. 113) (describing reconciliation process if predicted income differs from actual income).
229. See id. § 36(f)(2)( A).
230. Julie Piotrowski, Health Policy Brief: Premium Assistance in Medicaid, HEALTH