*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***

Chapter 27 - Appeals

Effective:  December 1, 2006

27.05 - Appeal Issues

Archived:  June 1, 2016

Appeal Issues

Minnesota Health Care program applicants, enrollees and certain people with financial responsibility for enrollees may appeal any state or county action that affects eligibility, benefit level or cost sharing. The following are common examples of appeal issues:

l  Denial, reduction, cancellation, or closure of assistance.

l  Spenddown amount or premium amount.

l  Denial of insurance premiums as cost effective.

l  Denial of a good cause exemption, such as

n  Nonpayment of a MinnesotaCare or MA-EPD premium.

n  Non-cooperation with medical support. For more information about claiming good cause for late MA-EPD premiums, see MA-EPD Good Cause.

l  The agency's failure to act on an application within the timeliness standards.

l  Effective dates of coverage.

l  Denial of a request for waiver of assets because of undue hardship.

l  Requirement to pay parental fees or the amount of the fees.

l  Denial of a prior authorization request for medical services. See Provider Manual Chapter 5, Authorization, Fair Hearings section.

l  Denial, termination, or reduction of medical benefits.

l  Claims payment or non-payment for services already received.

Note:  Fee-for-service enrollees may contact the Member Help Desk at (651) 431-2670 or (800) 657-3739 for assistance in resolving benefit and service issues.

l  Restriction on use of Minnesota Health Care Programs identity card. See Minnesota Restricted Recipient Program (MRRP).

Note:  Send all appeal requests to the DHS State Appeals Office, regardless of whether the issue being appealed appears on this list.

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