In addition to the grievance processes offered by Molina Healthcare, members have the right to request a Fair Hearing from the State of Wisconsin at any time during the process. They have a right to request a Fair Hearing even if a complaint or grievance hasn’t been filed with Molina Healthcare and/or if a health care service the member or the member’s doctor requested has been denied, delayed, or modified. Members may request a State Fair Hearing by contacting the State of Wisconsin Division of Hearings and Appeals (DHA) within ninety (45) days after the order or action complained of.
If you want to talk to someone outside of Molina Healthcare Health Plan about the problem, call the HMO Enrollment Specialist at (800) 291-2002. The Enrollment Specialist may be able to help you solve the problem, or can help you write a formal grievance to Molina Healthcare Health Plan or to the Badger Care Plus and Medicaid SSI programs.
You may also file a complaint with the Wisconsin Badger Care Plus and Medicaid SSI Program. Please call Molina Healthcare’s Member Advocate if you need help to write a formal grievance to Molina Healthcare Health Plan or to the Badger Care Plus and Medicaid SSI programs.
The address to complain to the Wisconsin Badger Care Plus and Medicaid SSI Programs is:
Badger Care Plus and Medicaid SSI
Managed Care Ombuds
P.O. Box 6470
Madison, WI 53716-0470
If you want a Fair Hearing, send a written request to:
Department of Administration
Division of Hearings and Appeals
P.O. Box 7875
Madison, WI 53707-7875
The hearing will be held in the county where you live. You have the right to bring a friend or be represented at the hearing. If you need a special arrangement for a disability, or for English language translation, please call (608) 266-3096 (voice) Or (608) 264-9853 (hearing impaired).
We cannot treat you differently than other members because you request a Fair Hearing. Your health care benefits will not be affected. If you need help writing a request for a Fair Hearing, please call either the Badger Care Plus and Medicaid SSI Ombuds at (800) 760-0001 or HMO Enrollment Specialist at (800) 291-2002.
Members have the right to bring someone who knows about the case to attend the hearing with the member, if he/she wishes. Members may also seek legal counsel to represent them.