Your Rights

Medicaid Recipient Due Process (Appeal) Rights

Read about the hearing process

Right to Appeal Denial of Benefits

If you have been denied benefits and disagree with this decision, you may ask for an appeal. Contact your worker at the Department of Social Services who sent the letter denying benefits.

Right to Appeal Denial of a Specific Service

If a Medicaid health service is denied (or if it is reduced, terminated, or suspended), you will receive a letter by trackable mail. Please sign the required forms to accept delivery of the letter. The letter will come from the N.C. Division of Medical Assistance, or one of its vendors. The vendors are ACS, The Carolinas Center for Medical Excellence, HP Enterprise Services, MedSolutions, the Murdoch Center, Piedmont Behavioral Healthcare, ValueOptions, Crossroads Behavioral Healthcare, The Durham Center, Eastpointe LME, and Pathways LME. The letter describes the decision and why it was made. You have the right to appeal. The letter has instructions for how to appeal.

Read more about the hearing process
or
Call the Appeals Unit, Division of Medical Assistance at 919-855-4260
or
Call the Office of Administrative Hearings at 919-431-3000.

Privacy

Medicaid recipients are entitled to have their medical information be kept private.

Notice of Privacy Practices

Children's Right to Medically Necessary Health Care

A federal law requires Medicaid to provide all medically necessary health care services to Medicaid-eligible children. This is called Early and Periodic Screening, Diagnosis and Treatment (EPSDT), or Health Check. The services are required even if the services are not normally covered by children's Medicaid.

Medical Care Decisions and Advance Directives

If you are 18 are older, and able to communicate and make health care decisions, you have the right to make decisions about your medical and mental health treatment. The Medical Care Decisions and Advance Directive brochure outlines the steps that you can take to control decisions about your medical and mental health treatment should you become unable to make or express those decisions on your own.

Medical Care Desicions and Advance Directives Brochure, Expanded Version (PDF, 2 MB)

Complaints

If you are a Community Care of North Carolina/Carolina ACCESS (CCNC/CA) member, you have a right to make a complaint if you think your primary doctor has not provided good care.