Medicaid Appeal -Tutorial
Channel: Colorado Cross-Disability Coalition
Date: 2019-05-08

As of 2024
HCPF has changed the process for making sure benefits are continuing when there is an appeal.  They now have more staff so the appeals should come to HCPF and they should be able to get the benefits going without having to email Joelle Morrison.  This is welcome news as it is an inequitable process to have to know a specific email to keep benefits going when that is a constitutional right when appeals are timely filed.   Now, in MOST cases if you can file the appeal before the date of the adverse action, you need do NOTHING more.  The benefits will not stop.   

There are a few situations where a little extra effort might be necessary.  
1) You file an appeal within less than 2 business days before the benefits are set to end.  Example, you filed an appeal on Friday March 29th and benefits were set to end on Sunday March 31st or you file an appeal on April 30th for a May 01 termination. 
2)  You filed an appeal and benefits are not reinstated within 2 days.  You or your client should get a notice saying benefits are reinstated pending appeal.
3) You file an appeal after benefits have already terminated and need to be reinstated because the client did not get advance notice, or the notice was inaccessible, the client was in the hospital, etc.  

Here is what HCPF is NOW asking you to do.
Use to the member escalation web form (https://hcpf.colorado.gov/county-member-complaints) to be completed for these requests. Please select the ticket type as "Member Escalation" and the description box please write "Eligibility Appeals Escalation". The screenshot below is an example of what this should look like. Please be reassured that our teams (escalation and appeals) connected on this process to make sure that this flows in an expeditious manner. As we continue to work through the process, we are happy to provide updates, if any.