AHCA Office of Fair Hearings
Most Medicaid Fair Hearing requests must be filed with the Agency for Health Care Administration (AHCA or Agency). When requesting a Medicaid Fair Hearing, the notice of hearing rights provides important instructions specifying whether AHCA or the Department of Children and Families (DCF) is responsible for providing a Medicaid Fair Hearing.
Requesting a Medicaid Fair Hearing from AHCA:
Requesting a Medicaid Fair Hearing from AHCA will utilize AHCA’s new fair hearing intake process. A Medicaid Fair Hearing may be requested from AHCA’s Medicaid Hearing Unit intake by contacting:
Agency for Health Care Administration
Medicaid Hearing Unit
P.O. Box 60127
Ft. Myers, FL 33906
Telephone: (877)254-1055 (toll-free)
Fax: (239)338-2642
E-mail: MedicaidHearingUnit@ahca.myflorida.com
Obtaining Information from AHCA Regarding a Medicaid Fair Hearing Request:
AHCA’s Office of Fair Hearings (OFH or Office), is responsible for acknowledging Medicaid Fair Hearing requests filed with AHCA. The Office will assign a Hearing Officer who will schedule a hearing, or take other appropriate action, on the hearing request pursuant to Rule 59G-1.100, F.A.C. Contact information for the AHCA Office of Fair Hearings is:
Agency for Health Care Administration
Office of Fair Hearings
2727 Mahan Drive, MS#11
Tallahassee, Florida 32308
Telephone: (850)412-3649
Fax: (850)487-1423
E-mail: OfficeOfFairHearings@ahca.myflorida.com
Your Medicaid Fair Hearing Rights
Under Federal and State Law you have the right to file a Medicaid Fair Hearing request. Below are times when you can file a Medicaid Fair Hearing request:
- If you disagree with the denial, reduction, suspension or termination of Medicaid service or services made by AHCA for regular Medicaid or your Statewide Medicaid Managed Care Plan.
- If you disagree with AHCA’s denial of a For Cause plan change request.
- How to file a Medicaid Fair Hearing
- Deadlines for filing a Medicaid Fair Hearing
Other Important Information:
- If you are now getting a service or services that are scheduled to be reduced, suspended or terminated, you have the right to keep getting those services until a final decision is made in the hearing. To continue services you must make that request during the intake process.
- If your services are continued and the decision of the hearing is not in your favor, you may be asked to pay for the cost of those services.
- You, or someone legally authorized to do so, can ask for a complete copy of your file, including medical records, a copy of plan review criteria and guidelines, contract provisions, other documents, records and other information considered during your plan appeal process. These will be provided free of charge.