Appeals Unit

% of eligibility appeals that are resolved prior to the formal Fair Hearing process

58%Sep 2020

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Partners
  • Office of the Attorney General
  • DVHA Health Access Eligibility & Enrollment Unit
Story Behind the Curve

This metric tracks the percentage of eligibility appeal requests received during a month that are resolved prior to a formal fair hearing.  Because internal resolution may take longer than one month, the data points for previous months may be updated retrospectively.

This process benefits Vermonters by providing expeditious and favorable resolution to their eligibility appeals wherever possible. The appeals staff work to identify cases that can be resolved in the customer’s favor prior to expending resources on the formal Fair Hearing process before the Human Services Board.  The goal has been to resolve more than 50% in this manner.  Given that the unit consistently surpassed this goal in CY 2017, DVHA increased the goal to 65% for CY 2018.  

For CY 2019, we are reducing the target back to 50%.  The rationale is that having fewer cases that can be resolved internally actually represents system improvement (there are fewer cases where something went wrong that the appeals team can fix).  While we still want to address as many cases internally as we can, we do not necessarily want to increase the volume.

Last updated:  10/15/2020

Strategy

The HCAT will adhere to standard operating procedures for handling appeal requests and review cases for resolution within fifteen days of receipt.

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