Appeals, Hearings & Grievances

Medicaid Services

If you have questions after reviewing this information, please call our office at 855-643-8180.

  • For Medicaid members with issues regarding their Medicaid services.
  • For applicants and members with issues regarding Medicaid applications and renewals (eligibility).

What is a Grievance?

A grievance is an expression of dissatisfaction.

What is an Appeal?

An appeal is your request for a review of an Adverse Action. An Action is when a managed care organization (MCO) such as Amerigroup, Sunflower or United, or a state agency such as Kansas Department of Children and Families, Kansas Department of Aging and Disability Services or Kansas Department of Health and Environment:

  • Denies or limits a service you want;
  • Reduces, suspends or terminates  payment for a service you are getting;
  • Fails to authorize a service in the required time; or
  • Fails to respond to a grievance or appeal in the required time.

~ Portions taken from United 2015 Member Handbook, p.43

What is a Fair Hearing?

The state fair hearing is done through the Office of Administrative Hearings (OAH) with the State of Kansas. It is an opportunity for the member to speak about his/her issue. The member and MCO meet before a Presiding Officer that is an administrative law judge, who is an impartial individual. He or she will enter an initial order based upon what is presented by the agency and by you at the hearing.