This article is a section taken from Minnesota Health Care Programs (MHCP), a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.
Table of Contents
Minnesota Health Care Programs (MHCP) applicants and enrollees have the right to appeal different types of decisions. This policy is about appealing MHCP eligibility decisions. This includes decisions about what health care program someone is eligible for and whether or not someone is eligible for payment of long-term care services.
Applicants and enrollees receive written notice of their appeal rights whenever an action affects their health care coverage under MHCP. The notice also explains how to file an appeal. They may appeal when they believe that the county, tribal or state servicing agency made an incorrect decision or took an incorrect action about their application. People are not penalized for filing an appeal.
Only an application filer, for example, an applicant, enrollee, former enrollee or their authorized representative, can file an appeal. See the MHCP Authorized Representative policy for more information about authorized representatives. Providers and navigators do not have the right to appeal health care eligibility determinations.
There is no cost to filing an appeal. Applicants and enrollees may be reimbursed for reasonable and necessary expenses to attend in-person hearings or telephone hearings held at a location other than their home.
Deadlines for Appeals
The applicant or enrollee must request the appeal hearing within 30 days after receiving a notice of action, or within 90 days after receiving the notice with good cause.
They must show good cause for making a late request if they submit the appeal request within 31-90 days after the notice. The Minnesota Department of Human Services (DHS) appeals office determines good cause along with the other issues at the hearing.
Continuation of Benefits
Different actions have different advanced notice requirements. See the MHCP Notices policy for more information about notice timelines.
MHCP enrollees who receive 10 days or more advance notice can automatically have their benefits continued if they file their appeal by the effective date of the action on the advance notice. MinnesotaCare enrollees must continue to pay premiums in order to get coverage.
MHCP enrollees who receive notice five days or less in advance of the effective date of the action must file an appeal within 15 days from the date of the notice to continue benefits.
If an MHCP enrollee does not want benefits to continue, they must submit a request to their county, tribal or state servicing agency.
Filing an Appeal
Applicants and enrollees must file an appeal in writing or by phone. There are several ways to file an appeal. People can:
Complete the online Appeal to State Agency form (DHS-0033) or write a letter and
Mail to DHS State Appeals Office, PO Box 64941, St. Paul, MN 55155-0941,
Mail to county, tribal or state servicing agency or
- Deliver to DHS Information Desk at 444 Lafayette Road North, St. Paul, MN 55101.
Visit MNsure and log into their account to access an appeals form.
Fill out the Appeal Request Form on MNsure and:
Mail to MNsure, 81 East 7th Street, Suite 300, St. Paul, MN 55101-2211, or
- Email it to [email protected].
- Call the MNsure contact center toll-free at 1-855-366-7873.
County, tribal and state servicing agencies must forward appeals for MHCP coverage to the DHS Appeals Office.
Medical Emergency Appeals
Applicants and enrollees have a right to request an emergency expedited appeal if there is an immediate need for health services and failure to act could seriously jeopardize life, health, or ability to attain, maintain, or regain maximum function. DHS must take final action within three working days of receiving a request from a person that meets the criteria of an expedited appeal.
Applicants and enrollees may request an agency conference including a supervisor or the agency director, before the scheduled appeal hearing. The conference may be a phone conference or a face-to-face conference. People are not required to try to resolve an issue at the local level before filing an appeal. A person should request to withdraw the appeal if a conference or other informal means resolves the appeal, by sending a letter to the DHS Appeals Office. The county, tribal or state servicing agency must promptly submit an appeal request to the DHS Appeals Office while concurrently attempting to resolve issues locally.
People who file an appeal receive a notice by mail informing them of the date and time of the hearing. The notice provides a phone number or a location. The Appeal Hearings Information (DHS-2811) pamphlet explains details about the hearing.
Other Types of Appeals
In addition to eligibility appeals, the DHS Appeals and Regulations Division conducts fair hearings when related to covered services.
The Office of the Ombudsman for State Managed Care Programs provides information and assistance with the managed care grievance and appeal process available through the health plan and the state. An ombudsman is a neutral investigator who helps people enrolled in a managed care health plan. The ombudsman helps enrollees get needed health care and resolve billing problems.
Code of Federal Regulations, title 42, section 431.10
Code of Federal Regulations, title 42, sections 431.200 to 431.246
Code of Federal Regulations, title 45, sections 155.500 to 155.555
Minnesota Rules, part 7700.0101
Minnesota Statutes, section 256.045
Minnesota Statutes, section 256.0451
CREDIT: The content of this post has been copied or adopted from the Minnesota Healthcare Programs Eligibility Policy Manual, originally published by the Minnesota Department of Human Services.
This is also part of a series of posts on Minnesota Healthcare Eligibility Policies.