Medicaid Appeals

If you receive services funded by Medicaid, you have the right to appeal any denial, reduction, suspension, or termination of services. In North Carolina, Managed Care Organizations (MCOs) administer behavioral health services. You can appeal the MCO’s decision to do any of the following:

  • Stop providing a service that you have been receiving;
  • Cut the number of hours or units of the service you get;
  • Deny a request for services; or
  • Deny a request for a piece of equipment, a home modification, or assistive technology.

Our guide, Medicaid Appeals Involving Managed Care Organizations, provides step-by-step instructions on the appeal process.

Appealing a Denial or Reduction of Personal Care Services provides step-by-step instructions on how to represent yourself during a mediation and hearing regarding a denial or reduction in personal care service hours.

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