Applicant / Member Appeals Resources

Overview

Individuals have the right to appeal an action that denies, reduces, or terminates Medicaid / FAMIS coverage or services.

As part of the appeal process, an impartial representative will conduct a review to determine whether your request for coverage or services should be approved based on applicable law and policy. The end result of the appeal is a written decision. Decisions by the DMAS Appeals Division may be appealed to court for review of the record.

Please Note: If you lost coverage for not completing a renewal or submitting renewal verifications, you have 90 days after you lost coverage to return the renewal paperwork. Visit the Cover Virginia website to learn how you can complete your renewal. 

[PDF] Virginia Medicaid Client Appeals Process: At-A-Glance (English)
[PDF] Virginia Medicaid Client Appeals Process: At-A-Glance (Spanish)

[PDF] Virginia Medicaid Client Appeals Process: Step-By-Step (English)
[PDF] Virginia Medicaid Client Appeals Process: Step-By-Step (Spanish)