Medicaid appeals in Minnesota: hearing deadline and keeping benefits

Medicaid (Medical Assistance (MA), Minnesota's Medicaid program (MinnesotaCare uses the same appeal office)) denials in Minnesota

Medicaid agency

Minnesota Department of Human Services (DHS) and county or tribal agencies

Who holds the hearing

Minnesota Department of Human Services, Appeals Division (state human services judges)

Hearing deadline

30 days

The date you receive the written notice

If you are late

You can appeal up to 90 days after receiving the notice if you show good cause for filing after 30 days. The DHS appeals office decides good cause at the hearing.

How to ask for a hearing

• Form: Appeal to State Agency form (DHS-0033), online or printed, or a letter
• Mail: DHS Appeals Division, P.O. Box 64941, St. Paul, MN 55164-0941
• Fax: 651-431-7523
• In person: DHS Building, 444 Lafayette Rd. N., St. Paul, MN 55155
• Phone: MNsure Contact Center 1-855-366-7873 (651-539-2099) for eligibility appeals
• Online: Log in to your MNsure account and choose Appeals; or email the MNsure Appeal Request Form to dhs.mnsureappealsindexing@state.mn.us
• Phone: Questions about expedited Medical Assistance or MinnesotaCare appeals: DHS Appeals Office 1-800-657-3510 (651-431-3600 in the metro area)

edocs.dhs.state.mn.us · 1-855-366-7873

Mail address

DHS Appeals Division, P.O. Box 64941, St. Paul, MN 55164-0941

What to include

Your name, address and phone, the agency that sent the notice, the date of the notice and the date the action will happen, the program, and what the agency did that you disagree with and why. Say whether you want to keep your benefits at the current level, whether you have an emergency, and whether you need an interpreter. Name your representative if you have one, and sign and date it.

Keeping your benefits during the appeal

If the notice reached you 10 days or more before the change, your benefits continue if you appeal by the date the change takes effect. If you got the notice 5 days or less before the change, appeal within 15 days of the date of the notice to keep your benefits. MinnesotaCare enrollees must keep paying premiums. If you lose, you may have to pay back benefits you got during the appeal.

Law: Minn. Stat. 256.045, subd. 10; Minn. Stat. 256.045, subd. 3(j)

Faster (expedited) hearing

Check the emergency box on the appeal form and explain why, or call. If failing to act could seriously harm your life, health or ability to attain, maintain or regain maximum function, DHS must take final action within 3 working days of your request.

Law: Minn. Stat. 256.045, subd. 3(j)

Ombudsman

Ombudsman for State Managed Health Care Programs · 1-800-657-3729

Medicaid health plan (managed care) in Minnesota

Appeal to the plan first

If your Medical Assistance health plan denies, cuts or stops a service, appeal to the plan first. Federal managed care rules apply and take precedence over conflicting state rules. If the plan decides against you, you can ask DHS for a state hearing, and you can ask for an expedited hearing. The Ombudsman for State Managed Health Care Programs can help.

Then a state hearing

120 days

The date of the plan's appeal decision notice

If the plan is late

If the plan does not follow the appeal rules or deadlines, you can ask for a state hearing without waiting.

Optional outside medical review

Minnesota's state external review does not cover Medical Assistance or MinnesotaCare. In a state hearing about a medical decision, you can ask for an expert medical opinion from the state's external review organization, paid by DHS, and the judge may order a second medical opinion.

Law: Minn. Stat. 256.045, subd. 3a; Minn. Stat. 62Q.73, subd. 2; Minn. Stat. 42 CFR 438.402, 438.408

Write my appeal: free letters

Letter: Medicaid fair hearing request