If Medicaid makes a decision about your waiver services that you disagree with, you have rights. This guide explains how to respond, what steps to take, and what to expect.
1. Know Your Rights
You may appeal any Medicaid decision that:
- Denies, reduces, or terminates your services
- Fails to act on your claim promptly
- Affects your eligibility
- Is otherwise incorrect or unfair
You cannot appeal if the decision is due to a change in federal or state law that affects many people.
Key Due Process Rights:
- Written notice with reasons and laws cited
- At least 10 days’ notice before loss of services
- Right to appeal and continue services if requested within 10 days
2. Request an Appeal
As soon as you receive a written notice:
- Send an appeal request to the agency
- Use Certified Mail and keep proof of delivery
- Request to continue services during the appeal if they’ve been reduced or stopped
3. The Informal Conference
Before a formal hearing, you must participate in an Informal Conference.
- Held with representatives from the Operating Agency (ADMH, ADRS, ADSS) and Medicaid
- Can be held in-person, by phone, or via Zoom
- No legal rules or procedures—you can speak freely and submit any evidence
- A great chance to share your side and strengthen your case
4. The Fair Hearing
If you’re not satisfied after the Informal Conference, request a Fair Hearing before an Administrative Law Judge (ALJ).
Key Facts:
- Takes place in Montgomery, AL
- Not usually available virtually—ask for accommodations early
- You may represent yourself, bring a lawyer, or ask a friend to help
- You must follow court rules (civil procedure & evidence)
5. Building Your Case
Gather Evidence:
- Medical records
- Doctor or nurse letters
- Photos
- Communication records with agencies
Organize it well—number each document, make copies for the ALJ and Medicaid, and prepare a table of contents.
Call Witnesses:
- Doctors, caregivers, family—anyone who supports your case
- If they can’t attend, get a notarized letter from them
- You can question Medicaid’s witnesses too
6. Telling Your Story
Opening Statement Tips:
- Explain what the waiver does and what you will present
- Say what will happen if services are denied or reduced
- Emphasize risks like institutionalization or harm
Closing Statement Tips:
- State Medicaid didn’t prove its case
- Recap why the decision is wrong
- Ask the judge to rule in your favor
7. After the Hearing
- ALJ makes a recommendation within 30 days
- Medicaid has another 30 days to decide
- Medicaid can reject the judge’s recommendation
- To appeal beyond this, you must go to Alabama Circuit Court—consult a lawyer
Final Advice
- Act quickly and document everything
- Be clear, organized, and persistent
- You are entitled to fair treatment under federal law
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
Informal Conference: Sample Request Letter
[DATE]
ID / LAH / CWP WAIVERS:
Alabama Department of Mental Health ODice of Waiver Appeals
P.O. Box 301410 Montgomery, AL 36130-1410
ddoca.dmh@mh.alabama.gov
NOTE: ADMH also has a form you may fill out and submit to request an appeal if you prefer to do that. A copy of that form is included on the next page.
E&D / ACT / TA WAIVER:
Medicaid Waiver Appeals Coordinator Alabama Department of Senior Services P.O. Box 301851
Montgomery, Alabama 36130
SAIL WAIVER:
Alabama Department of Rehabilitation Services
Independent Living Program
602 South Lawrence Street
Montgomery, Alabama 36104
RE: Request for Appeal
Dear Coordinator:
I am writing [if applicable: on behalf of] to request an appeal of the [Alabama Department of Mental Health/Senior Services/Rehabilitation Services] decision to [explain what you are appealing and why you are appealing it]. [If you are including any documentation with this letter, list it here].
[If you are appealing a termination, reduction, or suspension of services and you are sending this letter within 10 days of the notice, state that you want to continue services.]
Please contact me at [phone] or [email] regarding this appeal request. [If the waiver recipient’s contact information is different than yours, include it here.]
Sincerely,
[Your Name Here]
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
Fair Hearing: sample request letter
If the individual/guardian disagrees with the decision, they can submit a request for a Fair Hearing to the Alabama Medicaid Agency (Medicaid). A written hearing request must be received by Medicaid no later than 15 calendar days from the date of the decision letter.
Alabama Medicaid Agency
P.O. Box 5624, 501 Dexter Avenue
Montgomery, AL 36103-5624
Sample Request Letter
[DATE]
Long Term Care Division
Request for Hearing
Alabama Medicaid Agency
P.O. Box 5624
501 Dexter Avenue
Montgomery, Alabama 36130-5624
RE: Request for an Appeal
To Whom It May Concern:
I write today [on behalf of (if applicable)] to request a Fair Hearing before the Alabama Medicaid Agency.
[Explain the decision you are challenging and give a brief timeline. For instance, you may say something like: On March 1, 2018, John Smith made a request for (a service). On April 1, 2018, that request was denied. An Informal Conference was held on May 1, 2018, and the denial was upheld on May 15, 2018.]
[If you are filing on behalf of someone else, indicate here that you are filing as their Medicaid authorized representative.] I am hereby requesting a Fair Hearing regarding the [denial/termination/reduction] of [service]. [If you are including any documentation, such as copies of denials, indicate that here.]
[If you are filing on behalf of someone else, indicate here that you are enclosing a completed Appointment of Representative form. This form can be found on the next page.]
Please contact me at [phone] or [email] regarding this Fair Hearing request. [If the waiver recipient’s contact information is dinerent than yours, include it here.]
Sincerely,
[Your Name Here]
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
Disability Advocacy Solutions LLC 