Michigan Medicaid Fair Hearings
Medicaid Fair Hearings may be utilized for Healthy Michigan, Medicaid, and MI Health Link recipients who do not agree with an adverse (negative) action taken by a Community Mental Health Service Program (CMHSP) and Southwest Michigan Behavioral Health (SWMBH). Adverse actions include the reduction, suspension, or termination of a previously authorized service, denial or limited authorization of a requested service, and the denial, in whole or in part, of payment for a service. Fair Hearings may be requested only after a Local Level Appeal.
Medicaid Fair Hearings must be requested within 120 days of receiving an Appeal Resolution letter from your CMHSP or SWMBH. Hearing requests must be made in writing and signed by you or your authorized representative(s). You are encouraged to complete the Medicaid Fair Hearing form and send it to the Michigan Office of Administrative Hearings and Rules (MOAHR). If you do not have the form, you are able to request the hearing on any sheet of paper.
You have the right to request an expedited (faster) hearing if waiting the standard time (up to 120 days) for a hearing would seriously jeopardize your life, health, or ability to attain, maintain, or regain maximum function. To request an expedited Medicaid Fair Hearing, you may indicate it on your request form, or contact MOAHR:
Michigan Office of Administrative Hearings and Rules (MOAHR)
P.O. Box 30763
Lansing, MI 48909-9951
Feel free to contact your local Customer Service Representative, Southwest Michigan Behavioral Health, or MOAHR if you have any questions or concerns related to a Medicaid Fair Hearing