Member Appeals

You have the right to appeal decisions, also known as actions, made about your eligibility for programs or certain decisions made about your care.

What is an appeal?

An appeal is asking for a hearing because you do not agree with an action the state or your health plan is taking. You have the right to file an appeal if you disagree with the action. You do not have to pay to file an appeal.

How do I appeal an eligibility action?

If you want to appeal an action taken on your eligibility for Medicaid, you must follow the process in the notice you received from the Division of Family Resources (DFR). Anytime an action is taken on a members' case, the member will receive a notice from DFR explaining the action and appeal rights.

How do I appeal actions regarding my health care?

If you want to appeal an action your health plan took regarding your health care, you must appeal in writing:

• If you are on the Healthy Indiana Plan, Hoosier Healthwise, or Hoosier Care Connect, you should contact your health plan and work through their appeal process.
• If you are in any other Indiana Health Coverage Program, you can write a letter telling the Family and Social Services Administration (FSSA) why you think the action is wrong. Please make sure your name, the reason for the appeal request and the dates of the action is on the letter. Send your appeal to:

Family and Social Services Administration
Office of Administrative Law Proceedings - FSSA Hearings
402 W. Washington St., Rm E034
Indianapolis, IN 46204