Medicaid appeals in Arizona: hearing deadline and keeping benefits

Medicaid (AHCCCS (Arizona Health Care Cost Containment System)) denials in Arizona

Medicaid agency

AHCCCS Administration; eligibility for many groups is decided by the Arizona Department of Economic Security (DES) for AHCCCS

Who holds the hearing

Office of Administrative Hearings (for AHCCCS decisions) or DES Office of Appeals (for DES eligibility decisions); service appeals go through the AHCCCS Office of the General Counsel

Hearing deadline

35 days

The date on the decision letter (eligibility appeals); the agency must receive your request by the 35th calendar day

If you are late

A late eligibility appeal is denied, but you can ask for a good cause hearing. Good cause includes illness, not receiving the decision letter, or another reasonable explanation.

How to ask for a hearing

• Form: Use the Appeal Request Form or the 'I Am Asking For A Hearing' section printed on your decision letter (not required). Include your name, the decision you are appealing and the reason.
• Online: Health-e-Arizona Plus (HEAplus), except ALTCS
• Mail: Send eligibility appeals to the agency that made the decision (AHCCCS or DES), at the address on your letter. Appeals of denied, reduced or stopped medical services (fee-for-service members) go in writing to AHCCCS Office of the General Counsel, 150 N. 18th Ave., MD-15013, Phoenix, AZ 85007
• Fax: AHCCCS Office of the General Counsel fax 602-253-9115 (service appeals); for eligibility, the fax number on your letter
• Phone: Eligibility appeals can be made by phone; AHCCCS Office of the General Counsel 602-417-4232 or 1-800-654-8713 ext. 74232
• In person: Eligibility appeals can be made in person at the agency

www.healthearizonaplus.gov · 1-800-654-8713

Mail address

AHCCCS Office of the General Counsel, 150 N. 18th Ave., MD-15013, Phoenix, AZ 85007

What to include

Your name, the action or decision you are appealing, and the reason for your appeal.

Keeping your benefits during the appeal

To keep receiving a service while you appeal, file the appeal before the day the reduction, suspension or termination takes effect. If there are fewer than 10 days between the notice date and the effective date, file within 10 days from the notice date. Ask your health plan (or AHCCCS) to continue the services. If you lose, you may have to pay for the services you received during the appeal.

Law: 42 CFR 431.230, 438.420; 42 CFR 431.220-431.221

When the hearing is held

The notice of hearing is sent 20 to 30 days before the hearing date, unless you were approved for an expedited appeal.

Faster (expedited) hearing

For eligibility appeals, you can ask for an expedited appeal with a statement from a medical provider that you have (or cannot schedule) a procedure or treatment, have no insurance to cover most of it, and that waiting 90 days or less would put your life, health or ability to regain full function at serious risk. Expedited eligibility appeals must be resolved within 7 working days.

Law: 42 CFR 431.220-431.221

Ombudsman

AHCCCS Office of Individual and Family Affairs (OIFA) · 1-800-654-8713

Medicaid health plan (managed care) in Arizona

Appeal to the plan first

If you are enrolled in an AHCCCS health plan, contact the plan's Grievance and Appeals Department or member services to appeal, in writing or by phone. The plan should decide within 30 days; if waiting could seriously harm your health, ask for an expedited appeal, which the plan should resolve within 3 working days. If you disagree with the plan's appeal decision, you can ask for a State Fair Hearing before an administrative law judge. Members with a Serious Mental Illness designation may have a separate formal appeal process.

Law: AHCCCS OIFA, How to File an Appeal of a Health Care Coverage Decision (2024-12-20); 42 CFR 438.402, 438.408

Write my appeal: free letters

Letter: Medicaid fair hearing request