AHCA Medicaid Fair Hearings

AHCA Office of Fair Hearings

Beginning March 1, 2017, most Medicaid Fair Hearing requests must be filed with the Agency for Health Care Administration (AHCA or Agency). When requesting a Medicaid Fair Hearing the notice of hearing rights provides important instructions specifying whether AHCA or the Department of Children and Families (DCF) is responsible for providing a Medicaid Fair Hearing.

Notices of Medicaid Fair Hearing rights issued prior to March 1, 2017 identify DCF as the Agency responsible for providing a Medicaid Fair Hearing.

Notices of Medicaid Fair Hearing rights issued on or after March 1, 2017 identify AHCA as the Agency responsible for providing a Medicaid Fair Hearing. The DCF will have limited Medicaid Fair Hearing responsibilities after March 1, 2017.

Requesting a Medicaid Fair Hearing from AHCA:

Requesting a Medicaid Fair Hearing from AHCA will utilize AHCA’s new fair hearing intake process. A Medicaid Fair Hearing may be requested from AHCA’s Medicaid Hearing Unit intake by contacting:

Agency for Health Care Administration
Medicaid Hearing Unit
P.O. Box 60127
Ft. Myers, FL  33906
Telephone: (877)254-1055 (toll-free)
Fax: (239)338-2642
E-mail: MedicaidHearingUnit@ahca.myflorida.com

Obtaining Information from AHCA Regarding a Medicaid Fair Hearing Request:

AHCA’s Office of Fair Hearings (OFH or Office), is responsible for acknowledging Medicaid Fair Hearing requests filed with AHCA. The Office will assign a Hearing Officer who will schedule a hearing, or take other appropriate action, on the hearing request pursuant to Rule 59G-1.100, F.A.C. Contact information for the AHCA Office of Fair Hearings is:

Agency for Health Care Administration
Office of Fair Hearings
2727 Mahan Drive, MS#11
Tallahassee, Florida 32308
Telephone: (850)412-3649
Fax: (850)487-1423
E-mail: OfficeOfFairHearings@ahca.myflorida.com

Your Medicaid Fair Hearing Rights

Under Federal and State Law you have the right to file a Medicaid Fair Hearing request. Below are times when you can file a Medicaid Fair Hearing request:

  • If you disagree with the denial, reduction, suspension or termination of Medicaid service or services made by AHCA for regular Medicaid or your Statewide Medicaid Managed Care Plan.

  • If you disagree with AHCA’s denial of a Good Cause plan change request.
You must be notified of your denial, reduction, suspension or termination of services or your denial of a Good Cause plan change in writing and it must include, at a minimum, instructions on:
  • How to file a Medicaid Fair Hearing

  • Deadlines for filing a Medicaid Fair Hearing

Other Important Information:

  • If you are now getting a service or services that are scheduled to be reduced, suspended or terminated, you have the right to keep getting those services until a final decision is made in the hearing. To continue services you must make that request during the intake process.
  • If your services are continued and the decision of the hearing is not in your favor, you may be asked to pay for the cost of those services.
  • You, or someone legally authorized to do so, can ask for a complete copy of your file, including medical records, a copy of plan review criteria and guidelines, contract provisions, other documents, records and other information considered during your plan appeal process. These will be provided free of charge.