MCO Contract Update RI EOHHS and Medicaid are in the process of establishing a new managed care contract. If you or a loved one currently have health coverage through RI Medicaid, it’s important to know that you don’t need to take any action at this time. When a new contract is in place, the State will send information about any next steps.
File an Appeal I got a letter saying my Medicaid coverage is ending. I think this is wrong. What can I do? If you don’t agree with our decision about your Medicaid eligibility, you can: Call the Department of Human Services at 1-855-697-4347. Someone can talk you through the Benefit Decision Notice. Be sure to have your Benefit Decision Notice and the case/identification number on-hand when you call. File an appeal. An appeal is a formal request asking for the decision to be reviewed at a hearing. How do I file an appeal? There are a few ways to request an appeal related to your Medicaid coverage. You can file an appeal: Online. Log into your account at healthyrhode.ri.gov and click on "file an appeal". By phone. You can file an appeal by calling HealthSource RI at 1-855-840-4774. In person. Visit a local DHS office near you. An appeal form is included in every Benefit Decision Notice. Fill out this form and bring it with you. By mail. An appeal form is included in every Benefit Decision Notice. Fill out this form and mail it to ATTN: Appeals State of Rhode Island, P.O. Box 8709, Cranston, RI 02920-8787. Instructions on how to file an appeal are also in your Benefit Decision Notice. What is a fair hearing? A fair hearing is a chance for you to tell an administrative hearing officer why you disagree with the decision about your Medicaid eligibility. An agency representative is also present at the hearing to explain the basis for their decision. By law, the administrative officer must review the facts of the case presented by both sides in a fair and objective manner. You can either represent yourself at the hearing, or you can be represented by anyone you choose, like an attorney, advocate, friend, or relative. You can call RIPIN at 401-270-0101 or RI Legal Services at 401-274-2652 to find out whether free legal assistance is available. What’s the deadline for submitting an appeal? You must file an appeal within 35 days after the date on the top of the Benefit Decision Notice Your Medicaid coverage will automatically continue during the appeal process. You do not need to pay the State for medical care you received if you lose the hearing.