Medicaid appeals in Kentucky: hearing deadline and keeping benefits

Medicaid (Kentucky Medicaid) denials in Kentucky

Medicaid agency

Kentucky Cabinet for Health and Family Services: Department for Medicaid Services (DMS) for covered services; Department for Community Based Services (DCBS) offices for eligibility

Who holds the hearing

Cabinet for Health and Family Services, Division of Administrative Hearings (the designated hearing agency)

Hearing deadline

30 days

The date of the notice. Eligibility: the request must be postmarked or received within 30 days of the notice. Covered services denied by DMS outside managed care: the request must be postmarked within 30 calendar days of the written notice.

Source: denied application, coverage ended, higher patient liability

How to ask for a hearing

• In person: Eligibility: ask for a hearing at your local DCBS office, in writing or orally (an oral request must be followed in writing).
• Mail: Eligibility: send a written request to the DCBS central office or your local DCBS office. Covered services (not managed care): send a written request to the Department for Medicaid Services as your notice instructs.
• Form: Use the hearing request instructions and any form that come with your notice.

1-855-459-6328

What to include

Say clearly that you want a hearing and why. For a denied or cut service, give the date or type of service. Keep proof of the date you mailed it.

Law: 907 KAR 1:560; 907 KAR 1:563; 907 KAR 17:010

Keeping your benefits during the appeal

Eligibility: if your hearing request about ending your Medicaid or raising your patient liability is received within 10 days of the advance notice, your coverage stays the same through the month of the final order; with good cause, a request within 20 days gets coverage reinstated. Covered services (not managed care): if your request is postmarked or received within 10 days of the advance notice date, you keep the service until the final order (not for time-limited benefits or if the only issue is a change in law). If you lose, continued benefits may count as an overpayment.

Law: 907 KAR 1:560, Section 5; 907 KAR 1:563, Section 5; 907 KAR 17:010

When the hearing is held

Eligibility: you get at least 20 days' notice of the hearing (you can ask for less to speed it up), and no more than 90 days may pass from your request to the recommended order. Covered services: the hearing is held within 30 days of the request unless the hearing agency allows more time, and the final order is due within 90 days of the request.

Law: 907 KAR 1:560, Section 6; 907 KAR 1:563, Sections 6 and 12; 907 KAR 17:010

Medicaid health plan (managed care) in Kentucky

Appeal to the plan first

Appeal to your Medicaid managed care organization (MCO), orally or in writing, within 60 calendar days of receiving its notice; an oral appeal must be followed by a signed written appeal within 10 calendar days. The MCO decides within 30 calendar days, or within 3 working days for an expedited appeal (either can be extended by 14 days). You can ask for a state fair hearing only after the MCO appeal; your written request must be postmarked or filed within 120 calendar days of the MCO's final adverse action letter. If you asked to continue benefits, they continue until 14 days after a decision against you unless you ask for a state fair hearing.

Then a state hearing

120 days

The date of the plan's adverse action letter at the end of its internal appeal

Law: 907 KAR 17:010, Sections 4 and 5

Write my appeal: free letters

Letter: Medicaid fair hearing request