Eligibility Appeals

“I (or my representative) would like to appeal a Medicaid eligibility decision or unusually long delay in an eligibility decision by Medicaid.”

Personal Information

 

Representative Information
Documentation

Please state why or how you think the agency erred or why you are appealing.

If you would like to attach the denial notice, authorized representative form/notice of appearance, or supporting documentation, please do so now. You will have an opportunity to do so later after your appeal is received.

Please save Microsoft Word documents as .PDF
Files must be less than 32 MB.
Allowed file types: jpg jpeg png txt rtf pdf zip.
Please save Microsoft Word documents as .PDF
Files must be less than 32 MB.
Allowed file types: jpg jpeg png txt rtf pdf zip.
Expedited Appeals

You can request an expedited appeal. This means your appeal will be resolved as quickly as possible instead of the standard 90-day timeframe. SCDHHS will grant or deny these requests as quickly as possible. If we deny your request to expedite, your appeal will follow the standard 90-day timeline.

While supporting documentation is not required, we encourage you to include any additional documents with the request for expedited review. SCDHHS will make its decision based on information available at the time of the request.

I would like to request an expedited hearing.

 

Please save Microsoft Word documents as .PDF
Files must be less than 2 MB.
Allowed file types: jpg jpeg png txt rtf pdf zip.
Accommodations

Do you or your representative require special accommodations?

 

Most hearings are held at the SCDHHS main office in downtown Columbia, where metered parking can be limited. Would you like us to reserve parking for you for purposes of the hearing?

The Office of Appeals and Hearings will make every effort to obtain and reserve parking for hearing participants. However, reserved parking is not guaranteed. You will be notified if we are unable to reserve parking for you.
Electronic Communications

You can receive all documents from the Eligibility Appeals Coordinators and Office of Appeals electronically. If you choose to receive communication electronically, the Office of Appeals or Eligibility Appeals Coordinators will send you a written confirmation. We will also send a test message to your email address and ask you to confirm you received it.

Please note: If you elect to receive communication electronically, we will email the message or document to you and it is presumed to have been delivered to you if it does not bounce back to us. If a message bounces back, we will resend it one more time. If the second attempt bounces back, we will place a copy of the correspondence or document in the mail to you.

I would like to receive all communications and documents from the Office of Appeals and the Eligibility Appeals Coordinators electronically.
I understand that all communication and documents will come to me via the email address I provide and will be presumed delivered if it does not bounce back.
Internal use only
Appeal taken by the Healthy Connections Member Contact Center via telephone
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