Medicaid appeals in Indiana: hearing deadline and keeping benefits

Medicaid (Indiana Medicaid (Indiana Health Coverage Programs, including the Healthy Indiana Plan (HIP), Hoosier Healthwise, Hoosier Care Connect and Indiana PathWays for Aging)) denials in Indiana

Medicaid agency

Indiana Family and Social Services Administration (FSSA); eligibility by the Division of Family Resources (DFR)

Who holds the hearing

Indiana Office of Administrative Law Proceedings (OALP), FSSA Hearings

Hearing deadline

33 days

For people already getting Medicaid, the effective date of the action shown on the notice; for applications, the date the notice was sent

How to ask for a hearing

• Phone: Eligibility appeals: call the Division of Family Resources at 1-800-403-0864
• Fax: Eligibility appeals: 1-888-436-9199 (FSSA Document Center); health care (service) appeals outside a health plan: OALP fax 317-232-4412
• Mail: Eligibility appeals: FSSA Document Center, P.O. Box 1810, Marion, Indiana 46952. Health care (service) appeals outside a health plan: Office of Administrative Law Proceedings - FSSA Hearings, 100 N. Senate Avenue, Suite N802, Indianapolis, IN 46204
• In person: Take your appeal to your local Division of Family Resources office
• Form: Administrative Appeal and Hearing Request, State Form 53932

1-800-403-0864

Mail address

FSSA Document Center, P.O. Box 1810, Marion, Indiana 46952

What to include

Your name, address and phone number, the mailing date of the notice and the case number on it, the names of everyone you are appealing for, the benefit (Medicaid or HIP) and whether it was denied, closed or changed. Attach a copy of the notice if you can. For a health care appeal, include your name, the reason for the appeal and the dates of the action. If someone represents you, include a signed letter or the Medicaid Authorized Representative form.

Keeping your benefits during the appeal

Your benefits continue without change if the DFR receives your appeal by 4:30 p.m. on the day before the effective date of the change (or the next business day if that day is not a business day). Benefits do not continue if you say you do not want them, or if the case closed for not paying a Medicaid premium or a HIP POWER account payment.

Law: 42 CFR 431.230; 405 IAC 1.1-1-3

When the hearing is held

OALP mails a notice of hearing at least 10 days before the hearing. A decision is due within 90 calendar days of the hearing request unless the hearing was continued.

Law: 405 IAC 1.1-1-3

Medicaid health plan (managed care) in Indiana

Appeal to the plan first

If you are on the Healthy Indiana Plan, Hoosier Healthwise or Hoosier Care Connect, appeal a health care decision in writing to your health plan first and follow its appeal process. If you are in any other Medicaid program or have no health plan, send your written appeal to the Office of Administrative Law Proceedings - FSSA Hearings.

Law: 42 CFR 438.402, 438.408

Write my appeal: free letters

Letter: Medicaid fair hearing request