How to Appeal a Medicaid Decision

Can I Appeal a Medicaid Decision?
Yes, you have the right to appeal:

  • If all the services you requested were denied
  • If part of the services you requested were denied
  • If you were offered different services than you requested
  • If the service provider did not submit for full amount of services you requested. (In this case, a doctor's note showing the need for the requested services must be included with the appeal.)

Is There Anything Besides Appealing That I Can Do to Get Services?
The provider that sent in your request for services can request a reconsideration, with additional information.  This must be done within 30 days of the denial.  You will get a new decision, and if services are denied again, you can appeal then.

How do I appeal?

You can request an appeal using one of these methods:

  1. complete an appeal request form online at:  http://www.adminlaw.state.la.us/HH.htm
    or
  2. send a written request for appeal to:

    Division of Administrative Law
    Health and Hospitals Section
    P. O. Box 4189
    Baton Rouge, LA 70821-4189
    (fax) 225.219.9823

    Or

  3. call: 225.342.5800 or 225.342.0443
    (Telephone appeals are allowed, but are not encouraged)

Use only one method to file your appeal. Do not duplicate the same appeal.

Do I Have to Get Another Doctor's Statement?
To win the appeal, you may need to get your doctor to give a statement with more details about why the services are needed. The doctor's statement should include the number of hours of services needed.

Can my Case Manager help with my appeal?
YES! Your case manager should have received training to assist you with an appeal.  He/she can help you gather the necessary information within the allotted time.

What Deadlines Apply?
The notice of denial will tell you when the appeal must be filed.  You must appeal before or by that date. Appealing within 10 days of denial may keep services you are already receiving from being cut while the appeal is going on. You must get a final decision on your appeal within 90 days of the date you file it, unless you request or agree to additional time.
 
Can Someone Help me with the Appeal?
You can have someone else represent your situation if you choose.  That person can be a friend, relative, attorney or other spokesperson.  The Advocacy Center (1-800-960-7705) helps.Click here to download a copy of the appeals form.