Complaints and Appeals

Medicaid Appeals Process and External Medical Review and State Fair Hearing Process

Medicaid Complaint Process

CHIP and CHIP Perinate Appeals Process

CHIP Complaint Process

An HHSC Policy Flexibility for Member State Fair Hearings ends on May 11, 2023

In January 2020, the federal government declared a public health emergency (PHE) in response to COVID-19. Under the PHE, the Texas Health and Human Services Commission (HHSC) provided certain flexibilities, including allowing Medicaid members more time to request a fair hearing. Instead of 120 days to request a fair hearing after the internal MCO appeal, members were given up to 150 days to request a fair hearing with HHSC during the PHE.

HHSC will be ending this flexibility on May 11, 2023.

Starting on May 12, 2023, if you receive a “Member Notice of MCO Internal Appeal Decision” and want to appeal it, you must file your request for a fair hearing with or without an external medical review no less than 90 calendar days and no more than 120 calendar days from the date the notice is mailed. State fair hearing requests filed past this deadline may not be reviewed. If you have any questions, please call our Member Services Department at 915-532-3778 or “Toll-Free” 1-877-532-3778.