How to Appeal a Medicaid Decision
Can I Appeal a Medicaid Decision?
Yes, you can appeal if:
- If all the services you requested were denied
- If part of the services you requested were denied
- If you were offered different services than you requested
- If the service provider did not ask for all of the services you requested. (You'll need a doctor's note explaining why these services are necessary when you appeal.)
Is There Anything Else I Can Do to Get Services?
The provider who requested the services for you can ask for a reconsideration with more information within 30 days of the denial. You’ll receive a new decision, and if services are denied again, you can appeal.
How do I appeal?
You can appeal by:
- Filling out an appeal form online at: http://www.adminlaw.state.la.us/HH.htm
or - Sending a written request for appeal to:
Division of Administrative Law
or
Health and Hospitals Section
P. O. Box 4189
Baton Rouge, LA 70821-4189
(fax) 225.219.9823 - Calling: 225.342.5800 or 225.342.0443
(Phone appeals are allowed, but are not recommended)
Choose only one way to file your appeal. Don’t file multiple appeals for the same denied service.
Do I Have to Get Another Doctor's Statement?
To win the appeal, your doctor may need to explain in detail why you need the services. This statement should say how many hours of service you need.
Can my Case Manager help with my appeal?
YES! Your case manager should be trained to help you gather the right information on time.
What are the Deadlines?
The notice of denial will tell you when to file your appeal. You must file an appeal by that date. If you appeal within 10 days of the denial, your current services won’t be stopped while your appeal is reviewed. You should get a final decision within 30 days of filing your appeal, unless more time is agreed upon.
Can Someone Help me with the Appeal?
You can have someone else speak for you if you want. This could be a friend, family member, lawyer or another representative. Disability Rights Louisiana can also provide assistance and be reached at 1-800-960-7705.