If you have been turned down for a Medicaid service, or you were receiving a Medicaid service, but it was reduced or stopped, you should receive a letter explaining why Medicaid will not pay for or cover the service. When this happens, you may have the right to a Medicaid Fair Hearing.
If you are enrolled in a Medicaid health plan, you must go through the plan’s appeal process before you can have a Medicaid Fair Hearing. The letter you received explaining why Medicaid will not pay for or cover the service is called a Notice of Adverse Benefit Determination and it tells you how to ask for a plan appeal. You can also call your plan to get more information.
If you ask for a Fair Hearing before you finish the plan’s appeal process, your request for a Fair Hearing may be turned down. When you finish the plan’s appeal process, you will receive a letter to explaining the plan’s decision. This letter is called a Notice of Plan Appeal Resolution. If the plan’s decision is not in your favor, you can request a Medicaid Fair HearingYou can ask for a Fair Hearing by calling the Medicaid Helpline at 1-877-254-1055 (TDD 1-866-467-4970), or in writing by:
When asking for a Fair Hearing, please include your name, phone number, mailing address, and email (if available). Please provide the name of the Medicaid recipient, their Medicaid ID number and some details about the services that were denied, reduced or stopped. You can also submit any notices related to the Hearing Request. It is also important to tell us your preferred method of contact: mail or email.
Important note about email communication – We must encrypt all emails to protect your personal information. If email is your preferred method of contact, you will receive encrypted emails from the Agency. This means you will need to create a password to open the email. Please read the encryption instructions for more information.
The Office of Fair Hearings will review your Fair Hearing request and send you a letter confirming that your Fair Hearing request was received. This letter has important information about the Fair Hearing process and instructions for communicating with the Office of Fair Hearing. The Office of Fair Hearing will send more information to you during the Fair Hearing process. It is very important that you read all documents sent to you by the Office of Fair Hearings and that you carefully follow the instructions.
Please read the Medicaid Fair Hearing brochure for more information about Medicaid Fair Hearings.
If you have not been turned down for a Medicaid service, but you need help getting medical care or Medicaid Services, you can submit a Medicaid Complaint.