You have the right to request an appeal of any action related to initial or continued eligibility for Medicaid, FAMIS, or Plan First. This includes delayed processing of your application, actions to deny your request for medical services, or an action to reduce or terminate coverage after your eligibility has been determined.
To request an eligibility appeal, notify DMAS in writing of the action you disagree with within 30 days of receipt of the agency’s notice about the action. You may write a letter or complete an Appeal Request Form (Spanish). Please be specific about what action or decision you wish to appeal. Please include: your name (and your child’s name if applicable) and ID number, your phone number with area code, and a copy of the notice about the action if you have it. Be sure to sign the letter or form.
Please mail appeal requests to:
Department of Medical Assistance Services
600 E. Broad Street
Richmond, Virginia 23219
Telephone: (804) 371-8488
For reduction or termination of coverage, if your request is made before the effective date of the action and the action is subject to appeal, your coverage may continue pending the outcome of the appeal. You may, however, have to repay any services you receive during the continued coverage period if the agency’s action is upheld.
After you file your appeal, you will be notified of the date, time, and location of the scheduled hearing. Most hearings can be done by telephone. The Hearing Officer’s decision is the final administrative decision rendered by the Department of Medical Assistance Services. However, if you disagree with the Hearing Officer’s decision, you may appeal it to your local circuit court.
For more information about the appeals process, visit www.dmas.virginia.gov/#/appealsresources