Medicaid Fair Hearing Process

If you are a consumer of mental health services, receive Medicaid, and feel that the services you receive from Detroit Wayne Integrated Health Network have been denied, suspended, reduced or terminated, you can file a request for Medicaid Fair Hearing.

 

You must do this in writing within 90 days of receiving the notice regarding your services.  If you do this within 10 days of receiving the notice, the services that were terminated, reduced or suspended will be reinstated until an administrative law judge rules on the facts presented at the hearing.  When submitting your written request, include the following information:

 

  • your name, address and phone number;
  • if you have one, the name of your guardian or legal representative and their phone number;
  • name of community mental health services program you are having trouble with;
  • a description of the services you think have been denied, suspended, reduced or terminated; and
  • how this denial, suspension, reduction or termination of services impacts your life.

 

This request should be mailed to The Administrative Tribunal, Post Office Box 30195, Lansing, Michigan 48909.  Once The Tribunal receives your request, they will assign a docket number to the request and mail you a Notice of Hearing.  The Notice of Hearing will identify the date, time and location of the hearing.

 

At the hearing, you, or your legal representative if you have one, and Detroit Wayne Integrated Health Network will have an opportunity to present your case to the Administrative Law Judge.  The judge will decide if the action taken by Detroit Wayne Integrated Health Network was correct according to fact, law, policy and procedure, and whether the services are medically necessary and appropriate in length, scope and duration.

 

If the judge finds in your favor, he or she will issue a decision that identifies a plan of correction for Detroit Wayne Integrated Health Network.  If the judge does not find in your favor, you may file a request for a rehearing or reconsideration, under certain circumstances.

 

If you would like more information regarding the Medicaid Fair Hearing Process, you can call The Arc at 734-729-9100.  If you need assistance with the Fair Hearing Process, you can contact Michigan Protection and Advocacy at 800-288-5923.

 

Phone code: 1441