Medicaid Grievances, Appeals, Notices, and Fair Hearings

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Grievances, appeals, notices, and fair hearings provide significant protections for Medicaid beneficiaries. The following information gives direction to beneficiaries on the process of appealing adverse decisions and provides tools for advocates when protecting a clients rights.

Overview

• The Role of Health Assistance Programs

Outlines and Guidance

• State Fair Hearing Rules: Some Observations about Differences (Health Assistance Partnership, 2005)
• Tips for Assisting Consumers with Medicaid Appeals and Fair Hearings (Health Assistance Partnership)  NEW
• Handling Medicaid Denial of Service Cases (Barbara Fisher, CCHEA)
• Preparing for Fair Hearings Re: Scope of Services Covered Under the Medicaid Program  (Michele  Melden, HAP, and CCHEA)
• SCHIP: Due Process Rights (Health Assistance Partnership)
• Fair Hearings: In-Person or Via Telephone (Health Assistance Partnership)

Sample Letters, Notices, and Flyers

• Was your Medicaid Cancelled or Denied? (Center for Civil Justice, Michigan) One-page flyer on hearing rights in Michigan with a request for hearing form on the reverse side.
• Need Health Care or Help Paying the Medical Bills?  (Center for Civil Justice, Michigan) Getting the most out of Medicaid   Brochure with basic information on Medicaid in Michigan, including the right to notice and right to appeal.
• Tens of Thousands of Parents and Kinship Caregivers are Likely to Lose Medicaid Coverage:  (Center for Civil Justice, Michigan) An article about major legislative changes to Michigan's program with information about what should be appealed and basic information on how to request an appeal.
• Pharmacies cannot deny prescriptions to Medicaid recipients who cannot pay their prescription co-payments:  (Center for Civil Justice, Michigan) Flyer on rights to prescription medications when clients can not afford co-pays
• TennCare Drug Store Notice (Tennessee Justice Center)
• TennCare Pharmacy Flyer (Tennessee Justice Center)
• Sample Denial of Service Termination Letter (Minnesota Department of Health Services)
• Member Rights (Minnesota DHS)
• Have you been asked to pay for medication your doctor has ordered? 
      (Minnesota DHS-General Assistance Medical Care)
• Have you been asked to pay for medication your doctor has ordered?
      (Minnesota DHS-MinnesotaCare, Minnesota's expanded Medicaid program)