A fair hearing is a meeting with a fair hearing officer and someone from the Department and you. You can talk about your complaint during the fair hearing, and the fair hearing officer will decide what to do.
You can appeal if the Department:
- Denies your application
- Stops your benefits or coverage
- Says that you will start to get fewer benefits
- Changes your premiums or co-payments
You can also appeal if you think we made a mistake about any decision. You must make your appeal within 60 days of when the action happened.
You may not get a fair hearing if the action happened because of a change in the law.
If you are in a managed care health plan, you can appeal any decision that the plan makes if you think it is wrong. Check your plan’s member handbook to find out how to make an appeal or call your plan for more information. The number is on your managed care health plan card.
Anyone who applies for or receives All Kids has the right to appeal the following decisions:
- Application refused
- Application for renewal denied or canceled
- Coverage ended because you didn’t pay
- Coverage ended because you weren’t eligible anymore
- The amount of the premium or co-payments
After August 1, 2016, you will be able to file an appeal online through the new DHS Manage My Case portal.