Who can appeal?
Anyone has the right to appeal any decision made by the Department of Health and Human Services (HHS) and to request an appeal hearing. No one may limit or interfere with this right.
How do I file an appeal?
Filing an appeal is an easy thing to do. Supplemental Nutrition Assistance Program (SNAP), Medicaid, Child Care Assistance, Family Planning Program, and Family Investment Program appeals may be made in person, by telephone or in writing. All other appeals must be requested in writing.
You can write a letter explaining the reason you disagree with the Department's decision or you can complete an Appeal and Request for Hearing form online at Appeal and Request for Hearing English version or Appeal and Request for Hearing Spanish version.
Appeal and Request for Hearing form
You can request this form from your worker or you can complete your request online. You can use the Appeal and Request for Hearing English version or the Appeal and Request for Hearing Spanish version. Please fill out the entire form and click the submit button at the bottom of the form. Your appeal request will be sent directly to Appeals. Your worker will be notified of your appeal request, if applicable.
If you have questions on how to complete the Appeal and Request for Hearing form, you may call Appeals at (515) 281-3094.
If you are writing a letter or you do not want to complete this form on-line, you can send or take your appeal request to your local office or you can submit it directly to Appeals:
Iowa Department of Health and Human Services
Appeals
1305 E Walnut Street, 5th Floor
Des Moines, IA 50319
Phone (515) 281-3094
FAX 515-564-4044
Email: appeals@dhs.state.ia.us
Is there a time limit on when I can file an appeal?
You must file an appeal within the timeframes listed. The time starts from the date on your Notice of Decision.
- Family Investment Program (FIP) state tax or debtor offset - 15 days
- SNAP state tax or debtor offset - 15 days
- Medicaid state tax or debtor offset - 15 days
- Child Support state or federal tax or debtor offset - 15 days
- SNAP - 90 days
- Medicaid eligibility – 90 days
- Medicaid fee-for-service coverage – 90 days
- Family planning program – 90 days
- Autism support program – 90 days
- Managed care organization health care decisions – 120 days from the date on the letter indicating the first-level review process has been exhausted
- Child abuse assessments - 90 days from the date on the Notice of Child Abuse Assessment
- Adult abuse assessments – 6 months from the date on the Adult Protective Notification
- All other appealable issues - 30 days or before the effective date of the adverse action
When the time limit for filing falls on a holiday or a weekend, the time will be extended to the next working day.
If you file your appeal within the appropriate timeframe and the Department determines you are eligible for a hearing, a hearing will be scheduled for you.
However, if any appeal is filed after the appropriate timeframe, but before 90 days, a hearing may still be granted if you are able to claim good cause. You do not have to show good cause for filing a SNAP, Medicaid eligibility, Medicaid fee-for-service, family planning program, or autism support program or child abuse appeal within the 90-day timeframe.
How do I claim good cause for not filing an appeal timely?
If your appeal is not filed within the timeframes listed above, but less than 90 days, a hearing may still be granted.
A hearing may be granted if one of the following reasons kept you from filing your appeal within the appropriate timeframes:
- A serious illness or death in your family.
- A family emergency or household disaster, such as a fire, flood or tornado.
- A failure to receive the Department's notice of adverse action for a reason beyond your control. (Failure to notify the Department you moved will not be considered.)
- Other good cause beyond your control.
If you want to claim good cause, you will need to send a written request explaining why you were unable to file your appeal within the appropriate timeframes. You will need to include written proof of your good cause claim. Written proof includes such things as funeral notices, letters from physicians, newspaper articles, etc. that explain why you could not file your appeal timely. Send your request to:
Department of Health and Human Services
Appeals
1305 E Walnut St, 5th Floor
Des Moines, IA 50319
FAX (515) 564-4044
Email: appeals@dhs.state.ia.us
If you have questions, you may call Appeals at (515) 281-3094.
If it is determined that you had good cause, your appeal will be scheduled for a hearing. A letter will be sent to you if it is determined that you do not have good cause. You may appeal the denial of your good cause claim. Please follow the instructions in your letter to file an appeal. If you appeal that letter, a hearing will be scheduled with an Administrative Law Judge to determine if the Department correctly denied your good cause claim. The hearing will not be about the merits of your case.
Who can file an appeal relating to a managed care organization or dental carrier decision?
When someone disagrees with an action taken by a managed care organization, federal regulations allow members, providers or authorized representatives to file an appeal. If a provider or authorized representative files an appeal, the Medicaid member must have given their express written consent before the appeal can proceed to a state fair hearing.
Member consent must be obtained on form 470-5526, Authorized Representative for Managed Care Appeals. Form 470-5526 shall be used to appoint an individual, organization or provider to act on behalf of the Medicaid member during the appeals process. Both the member and the provider, or the authorized representative must sign the form to make it valid. The form is required for the managed care organization (MCO) and dental carriers’ first level appeals process and for the Department’s state fair hearing process, and should be submitted with the appeal request.
Form 470-5526 includes the contact information for each MCO, dental carrier and HHS Appeals.
Federal regulations and the managed care contract do not allow providers to file appeals with HHS Appeals regarding claims payment disputes or post-service provider issues.
What is the first level review process?
First level review is a review process that must be exhausted through a managed care organization before an appeal hearing is granted. The first level review process is mandated by federal regulations.
The managed care organization will review information submitted by the Medicaid member and the member’s medical provider to make a decision on the first level review. Once this process is complete, a notice of decision will be issued by the managed care organization that explains the right to request a state fair hearing.
If a request for state fair hearing is filed before the first level review is complete, the state fair hearing request will be denied and HHS Appeals will ask the MCO to initiate a first level review, if applicable.
A state fair hearing request is filed with HHS Appeals. Staff will obtain a copy of the first level review outcome letter from the managed care organization. HHS Appeals will review the request to ensure it was filed timely and that member’s consent has been obtained, if the request was filed by a provider or authorized representative. If all hearing requirements are met, the appeal file is forwarded to the Department of Inspections, Appeals and Licensing so an appeal hearing can be scheduled.
If the request for a state fair hearing is denied as premature, HHS Appeals will forward the request to the managed care organization so the first-level review process can be initiated.
What is a reconsideration process?
Reconsideration is a review of the situation by a third party who was not involved in making the initial decision.
When you file an appeal for certain programs, you will need to complete the reconsideration process first.
If your appeal is denied as being premature, the denial letter will instruct you on how to complete the reconsideration process.
NOTE: The reconsideration process does not apply to child abuse or managed care appeals.