Your Medicaid complaints, grievances and appeals in Florida

SMMC Medicaid is health insurance that helps people with low income. It helps pay for doctor visits, medicine, hospital care, and other health needs. Medicaid helps children, adults, and families.

Children’s Medical Services (CMS) Plan by Molina Healthcare is a special program that works with Medicaid. It helps children and teens who need extra care. This could be for serious or long-term health conditions. This may include special doctors or treatments. Click here to learn more about the CMS Plan.

Learn about complaints, grievances and appeals, how to file and where to get help.

Complaints and grievances

A grievance is when you tell us that you are unhappy with something, but it is not about a decision on your child’s care. If you would like to file a grievance, you have to file a complaint first.

Examples of complaints include:

• You wait too long at the doctor’s office.
• The doctor or staff is rude.
• No one answers the phone.
• You do not get the facts you need.
• The doctor’s office is not clean.
• You can’t find a doctor near you.
• You can’t get your medicine.

An appeal is when you are unhappy with a decision we made about your child’s care. This decision is called a Notice of Adverse Benefits Determination (NABD).

For more about Complaints, Grievances, and Appeals Process, please look at your Member Handbook.

Appeals

You can file an appeal when you do not agree with our decision to: 

• Change, suspend or reduce a service
• Stop or deny a service 
• Deny payment for services provided 

  How to file a complaint, grievance or appeal:

You can file a complaint, grievance or appeal by: 

• Phone. Call SMMC Medicaid Member Services at (866) 472-4585 or CMS Plan Member Services (800) 262-0750 (TTY: 711) Monday - Friday, 8 a.m. – 7 p.m. local time.  

• Mail. Fill out a grievance/appeal request form and mail it to:

Molina Healthcare of Florida, Inc.

Appeal and Grievance Unit

P.O. Box 36030

Louisville, KY 40233-6030

• Email. Email us at MFLGrievanceandAppealsDepartment@molinahealthcare.com
• Fax. Fill out a grievance/appeal request form and fax it to (877) 508-5748

Be sure to include the following information:

• Your first and last name
• Your signature and the date
• Your Molina ID number (on the front of your member ID card)
• Your address and telephone number
• Facts about the issue

If you wish to talk in your own language, a translator can help you file the request. You can get this service at no cost.

If you want a family member or your doctor to file a complaint, grievance or appeal for you, we need your written permission.

For more information, check your Member Handbook.