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Home  •  Waiver & Medicaid Services  •  Innovations  •  What If I’m Denied?

Innovations Waiver

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What If I’m Denied?

  1. Submit your appeal form to the Office of Administrative Hearings (OAH) within 30 days of the date of your denial letter to:

    Office of Administrative Hearings
    Attention: Clerk of Court

    1711 New Hope Church Road
    Raleigh, NC 27609

    Telephone: 984-236-1850    Fax: 984-236-1871
    Consider sending via Fax and keep receipt confirmation and/or sending via mail with delivery confirmation.

    ***If you are being denied services you are currently receiving, you must appeal within 10 days to continue receiving services during the appeal process time.

  2. Gather documentation (past or new) to counter the denial reason and submit to OAH within 3 business days prior to your mediation (not required, just best practice). Documentation might include things such as letters from physicians, therapists, & other service providers.
  1. The mediator will call you to schedule mediation. This will be a meeting between you and a Medicaid nurse consultant to discuss your case in the presence of a mediator. These are conducted by phone. HAVE SOMEONE ATTEND WITH YOU! Based on AFMFKNC experience, having a support person to act as a witness/scribe and/or a calming presence can significantly impact the outcome. 
  1. Attend mediation. Have your documentation in front of you and be familiar with it so you can reference it as needed. You may also want to share it with your support on the call. Remain calm and have a respectful conversation. 
  1. If you don’t come to an agreement at mediation, this is called an “impasse.” The next step is a preliminary hearing. You will be contacted at a later date to get this scheduled. This is also by phone. 
  1. For the preliminary hearing, an administrative court judge will initially be present, along with the Medicaid attorney. The judge will ask that everyone try to reach an agreement and then leave the call to allow the Medicaid attorney, the Medicaid nurse consultant, and you (and your support person/people) to try to reach an agreement. If still at an impasse, then scheduling a full hearing is next.
  1. A full hearing before the judge is also typically by phone. If you have any witnesses to testify, this is the time to coordinate with them to ensure they can participate in a conference call.