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.
Applicant / Member Appeal Resources
Applicant / Member Appeal Forms
Client Appeal Request Form [pdf]
Formulario de solicitud de apelación del cliente [pdf]
Authorized Representative Form [pdf]
Formulario de representante autorizado [pdf]
Appeal Withdrawal Request [pdf]
Solicitud de retiro de apelación [pdf]
Good Cause Questionnaire for Non-MCO Appeals [pdf]
Cuestionario de causa justificada para apelaciones (que no son con una MCO) [pdf]