Medicaid is an “entitlement.”
This means that if you meet the eligibility requirements, you
have a right to services under the program when they are
medically necessary. The state cannot deny, reduce, or take
away your benefits without “due process,” which means they
need to send you a legally sufficient notice and give you an
opportunity to say why you should be able to get benefits.
You may consider filing an appeal to the Office of Administrative Courts (OAC) if:
- A service or benefit is reduced or denied
- Your request for a new service/benefit is denied
- Your notice of change or denial is not a “Legally Sufficient Notice”
In this guide (also available in Spanish here), you’ll learn what makes a notice “legally sufficient,” how to request an appeal and what information must be provided, where and when to file your appeal, and who may be available to assist you with your filing.