1. File a Notice of Appeal
- Your local Family Community Resource Center can give you an appeal form and will help you fill it out, if you wish;
- You can file an appeal by writing to the Bureau of Administrative Hearings, 401 South Clinton Street, Chicago, Il 60607;
- Or you may call 1-800-435-0774 (TTY: 1-877-734-7429). The call is free.
After you file the appeal, DHS will hold a pre-hearing conference. You will meet with the caseworker and her supervisor. If the denial was due to a misunderstanding about the facts, you could win your case at this stage.
To continue Medicaid benefits during an appeal, you must appeal within 10 days of the date of the notice of change or before the date the change becomes effective (the date the change becomes effective is included on the notice of change). Be sure to get a record that you filed your appeal showing the date you filed it.
2. Present your case at a fair hearing
If DHS does not approve your request at the pre-hearing stage, they will schedule a fair hearing. At the hearing you will have the opportunity to present your case before a hearing officer, and DHS will then issue a written decision. At the hearing, you have the following rights:
- To be represented by a lawyer, a friend or relative
- To bring in witnesses
- To show documents supporting your case, such as medical records and your doctor's’ statements
If you win your appeal, your Medicaid coverage will be retroactive to the date that coverage would have started if your application had been approved, or the date your coverage would not have been ended.
3. File a lawsuit for review by a court
If the hearing officer rules against you, you may file a lawsuit in the Illinois Circuit Court. You must file the lawsuit no later than 35 days from the date that the decision was sent to you. This process is very difficult so you should talk to an attorney before starting it.
During the lawsuit, you or your lawyer will argue your case to the judge. The judge will then decide whether HFS and the hearing officer fairly looked at the facts and properly applied the law. The judge will not hear new evidence that was not presented before.
The judge can approve your claim, deny your claim, or send your case back to HFS for a new hearing.
Learn more about Starting a lawsuit.