Customer concerns and questions may include, but are not limited to: Medicaid and other Insurance benefits, CMH covered services, local appeals, State Fair Hearings, second opinions, grievance procedures, and the Family Support Subsidy appeal process.
When a decision is made to reduce, terminate, suspend, or deny services you will receive a Notice of Adverse Benefit Determination. If you do not agree with the decision that was made, you may request a local appeal from CMHCM. An appeal can be started through a verbal or written request. Medicaid enrollees and MI Health Link enrollees have sixty (60) calendar days to request a local appeal from the date of the Notice of Adverse Benefit Determination. Non-Medicaid enrollees have thirty (30) calendar days to request a local dispute resolution from the date of the Notice of Adverse Benefit Determination. In every case, CMHCM customer service staff have thirty (30) calendar days to provide a resolution.
State Fair Hearing
If you are unhappy with the outcome of the local appeal, you can request a second decision from a higher authority by requesting a State Fair Hearing. For Medicaid and MI Health Link members seeking a second decision on a Medicaid covered service, a State Fair Hearing must be filed within one hundred and twenty days (120) calendar days from the date on the Notice of Adverse Benefit Determination. For uninsured or underinsured enrollees, there is a ten (10) calendar day timeframe in which an alternative dispute resolution can be requested from the date on the Notice of Adverse Benefit Determination.
You have the right to say that you are unhappy with your services, supports, or the staff who provide them, by filing a grievance. You will receive an acknowledgment letter within three (3) to five (5) calendar days of receipt of your grievance. You can file a grievance verbally or in writing. Grievances are investigated and will be resolved within sixty (60) for non-Medicaid and ninety (90) calendar days for Medicaid covered individuals. You can request an expedited resolution and you have the right to have your grievance resolved as quickly as possible should your condition warrant immediate attention. CMHCM staff will assist you with this determination.
Should you wish to have someone else file a grievance on your behalf, you may do so; however, written authorization is required to have a representative speak on your behalf. Therefore, should a grievance be submitted by a representative without written authorization, it will not be processed until receipt of proper documentation.
Family Support Subsidy Appeal
When a Family Support Subsidy application is denied or a family support subsidy is terminated, the parent or legal guardian of the affected eligible minor may request a second opinion in writing within sixty (60) days of the Notice of Adverse Benefit Determination. A receipt of Appeal will be sent to the individual indicating the information about the scheduled hearing, or a response indicating that the appeal was not received within two months of the action was not received within sixty (60) days of the determination and therefore, no appeal can be completed.