Medicaid Policy
Effective Date: July 1, 2002
No Previous Policy
A. Complaints
When an applicant or recipient disagrees with an eligibility decision or has an issue with how services are provided, the person may make a complaint in person, by phone, or in writing. Complaints may be taken at the local office or outreach site, or referred to the eligibility agency's Constituent Services Representative. Complaints must be resolved as quickly as possible. The response to a complaint may be given in person, by telephone, or in writing.
B. Agency Conferences
An agency conference is a less formal procedure than a fair hearing. Its purpose is to quickly resolve problems that are simple and straightforward.
The agency conference is not mandatory.
The client has the right to proceed with a formal fair hearing regardless of the outcome of the agency conference, as long as the client requests a hearing in a timely manner.
The client may request a fair hearing if the agency takes any new adverse case action as a result of the agency conference.
The client and agency staff, including a supervisor, participate in the agency conference.
Document the results of the agency conference in the case record. Take any appropriate case action.