In 2016, the Federally-Facilitated Marketplace (“FFM”) will begin notifying employers if an employee has been determined to be eligible for Advance Premium Tax Credits (“APTC”) and Cost Sharing Reductions (“CSR”) because the employee attested that he or she was not:
• enrolled in employer sponsored coverage, or
• eligible for employer coverage that is affordable and meets minimum value requirements.
The first batch of notices was expected to be released in the spring of 2016. Department of Health and Human Services anticipates the first will be the largest batch of notices as it will include employers whose employees enrolled in Marketplace coverage with APTC during Open Enrollment which ended on January 31, 2016. Additional batches of notices are expected throughout 2016.
In the FFM, the employer has 90 days from the date of receipt of the notice to submit a state-specific appeal form by fax or mail. The appeal request form is available here: https://www.healthcare.gov/downloads/marketplace-employer-appeal-form.pdf.
The following states have an FFM: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming.
Some states, such as California, Colorado, the District of Colombia, Maryland, Massachusetts, New York and Vermont have a state-based Marketplace, but will use the Federal appeals process. Other states, including Washington and Connecticut, have adopted their own appeals process.
For applicable large employers, subject to the employer mandate, these subsidy notices are not a notice of a penalty assessment. Penalty assessment determinations are made by the Internal Revenue Service (“IRS”) in the year that follows the calendar year to which any assessment relates. However any applicable large employer that receives a notice from the FMM or a state Marketplace should carefully review current year records to determine whether the employee identified in the notice is an ACA full-time employee.
For more information, visit: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Employer-Notice-FAQ-9-18-15.pdf