ColoradoColorado

Your Right to Appeal

Authored By: Colorado Legal Services

Information

The following information is provided by Colorado Legal Services. It is intended as general information only, and is not meant as legal advice for any specific situation. If you need legal advice, consult an attorney.

Your Right to Appeal a Medicaid Decision

If you receive a notice of action regarding your Medicaid benefits that you believe is incorrect, or if the county department does not act on your application within a reasonable time period, you have a right to a county conference and/or a state hearing.

County Conference:  This is an informal meeting with county staff other than the worker taking the action.  If you want a county conference, you must contact your county worker before the effective date of the proposed change in your Medicaid benefits.

State Hearing: If you disagree with a county conference decision, or if you want to skip the county conference, you may request a state level hearing. Your request must be received by the Office of Administrative Courts within thirty (30) days from the date of the notice of action. Keep a copy for your records.

To request a state level hearing, you must mail or fax a written request, including your name, address, a copy of the notice of action if available, and the reason you disagree,  to:

Office of Administrative Courts
633 17th Street, Suite 1300
Denver, CO 80202

Fax # 303-866-5909

http://www.colorado.gov/cs/Satellite/DPA-OAC/OAC/1194261892662

Continuation of Benefits: If you request a county dispute resolution conference or a state hearing prior to the effective date of the notice of action, or within ten (10) days of the issuance of a dispute resolution conference decision, your benefits should continue until you receive a final decision.  You may request that your benefits not continue during the appeal.

Impact of Appeal: If your appeal is not successful, you may be asked to pay the cost of benefits received while the appeal is pending, although this is not common. If the final decision of your appeal is favorable, the corrective action will be retroactive to the date the initial action was taken. If your assistance is discontinued or denied, you may reapply for assistance at any time. Recovery of Medical Assistance from Estates: Under federal and state law, the state of Colorado has authority to recover the costs of certain medical assistance from the estates of deceased medical assistance recipients, including Medicaid benefits paid when the individual was over the age of 55 or institutionalized. In order to recover the medical assistance costs, the state may place a lien on property of or file a claim against the estate of the deceased Medicaid recipient. The federal and state laws provide for certain exemptions to this recovery. For further information or questions, you can contact your county technician and request "The Medical Assistance Estate Recovery Program" brochure.

Denial of Medicaid for Children and Pregnant Women: If a pregnant woman or a child under the age of 18 is not eligible for Medicaid due to excess income or resources, that individual may be eligible for Child Health Plan Plus. Child Health Plan Plus is low-cost health insurance for children and pregnant women with household incomes too high to qualify for Medicaid but who cannot afford private insurance. A Medicaid application for children and pregnant women will also be considered an application for Child Health Plan Plus eligibility.

Unfair Treatment: If you believe that you have been unfairly treated because of race, national origin, disability, or age, you have a right to complain to your County Department of Social Services or the State Department of Human Services. You can also file a written complaint with the federal government:

U.S. Department of Health and Human Services 
Office of Civil Rights 
999 18th Street, Suite 417
Denver, CO 80202
(303) 844-2024

or

U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
(800)368-1019

Last Review and Update: Mar 01, 2013