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Your right to appeal

You have the right to ask DMAS for an appeal of any action that keeps you from having coverage or getting services through Virginia Medicaid. You can appeal a delay in processing your application, a denial of your request for medical services, or an action to reduce or end coverage after you were found eligible.

If you are appealing an action made by a health plan, you must use your internal appeal rights with the health plan before appealing to DMAS. 

To ask for an appeal, write a letter or complete an Appeal Request Form ([PDF] English form [PDF] Spanish form). Tell us the action you disagree with. Your letter or form should include:

  • Your name (and your child's name if applicable)
  • Member ID number
  • Phone number with area code
  • A copy of the letter you received about the action
  • Any documents you want DMAS to consider during your appeal

Be sure to sign the letter or form. You should send your appeal request within 30 days of receiving the letter about the action you disagree with.

Ask for an appeal in one of these ways:

                  Appeals Division, Department of Medical Assistance Services
                  600 E. Broad Street
                  Richmond, VA  23219

  • By phone: 1-804-371-8488 (TTY: 1-800-828-1120)

In some cases, you may be able to keep coverage during an appeal about an action to reduce or end that coverage. If you lose the appeal, you may have to pay for any services you got during the continued coverage period.

After you file your appeal, DMAS will tell you the date, time and location of the hearing if you qualify for one. Most hearings can be done by phone. The Hearing Officer’s decision is the final decision by the Department of Medical Assistance Services. If you disagree with the Hearing Officer’s decision, you may appeal it to your local circuit court.

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