Medicaid appeals in Illinois: hearing deadline and keeping benefits

Medicaid (Illinois Medicaid (medical assistance, including All Kids and HealthChoice Illinois managed care plans)) denials in Illinois

Medicaid agency

Illinois Department of Healthcare and Family Services (HFS); eligibility is handled by the Illinois Department of Human Services (IDHS) Family Community Resource Centers

Who holds the hearing

IDHS Bureau of Hearings (eligibility: denials, terminations, spenddown and other case actions, and some waiver and behavioral health services); HFS Bureau of Administrative Hearings (medical services and items, including appeals after a managed care plan decision)

Hearing deadline

60 days

The date of the Department's notice of the action

How to ask for a hearing

• Online: ABE appeals portal: abe.illinois.gov/abe/access/appeals
• Phone: IDHS Bureau of Hearings 1-800-435-0774 (TTY 1-877-734-7429); for medical services and items, HFS Bureau of Administrative Hearings 1-855-418-4421 (TTY 1-800-526-5812)
• Mail: IDHS Bureau of Hearings, 69 W. Washington Street, 4th Floor, Chicago, IL 60602; for medical services and items: Illinois Department of Healthcare and Family Services, Bureau of Administrative Hearings, 69 W. Washington Street, 4th Floor, Chicago, IL 60602
• Fax: IDHS Bureau of Hearings (312) 793-3387; HFS Bureau of Administrative Hearings (312) 793-2005
• In person: Take a written, signed request to your local IDHS Family Community Resource Center
• Form: IDHS Appeal Request Form IL444-0103 (SNAP, Medical Assistance, Cash Assistance, Child Care)

abe.illinois.gov · 1-800-435-0774

Mail address

Illinois Department of Human Services, Bureau of Hearings, 69 W. Washington Street, 4th Floor, Chicago, IL 60602

What to include

Your name, date of birth, phone, address and email, the name and number of the case, the program (Medical Assistance), the date of the notice you are appealing, and why you want a hearing. Say if you need an interpreter and which language, and whether you want your benefits to continue. Attach the notice if you can. If someone else signs for you, attach your written authorization.

Law: 89 Ill. Adm. Code 14.10(f)(1); 89 Ill. Adm. Code 104.1, 104.10

Source: form IL444-0960

Keeping your benefits during the appeal

Your benefits continue at the previous level if you file your appeal by the later of the date of the change or the 10th calendar day after the date of the notice. If that day is not a workday, an appeal received or postmarked by the next workday counts. Mark "I want my benefits to continue" on the appeal form. If you lose, you may have to pay back the benefits.

Law: IDHS Appeal Request Form IL444-0103; 89 Ill. Adm. Code 14.10(f)(1); 89 Ill. Adm. Code 104.1, 104.10

When the hearing is held

The local office will schedule a pre-hearing meeting with you within 10 days after it receives your appeal. You get written notice of the hearing at least 10 days before it. A final decision is due within 90 days after you ask for the hearing, extended by any delay you ask for.

Law: 89 Ill. Adm. Code 14.15, 14.70(b); 89 Ill. Adm. Code 14.10(f)(1); 89 Ill. Adm. Code 104.1, 104.10

Medicaid health plan (managed care) in Illinois

Appeal to the plan first

First appeal to your Medicaid health plan within 60 calendar days of the date on its Notice of Adverse Benefit Determination. If the plan says no, you can ask for a State Fair Hearing within 120 calendar days of the date on the plan's Notice of Appeal Resolution. To keep your services during the hearing, you must ask within 10 calendar days of that date. Send hearing requests about medical services to the HFS Bureau of Administrative Hearings; requests about mental health, substance use, certain waiver services or the Home Services Program go to the IDHS Bureau of Hearings.

Then a state hearing

120 days

The date on the health plan's Notice of Appeal Resolution

Law: 42 CFR 438.402, 438.408, 438.420

Write my appeal: free letters

Letter: Medicaid fair hearing request