Independent medical reviews in Florida
Learn about your right to file an external appeal.
If you asked for an appeal but did not get a letter, and more than 30 days have passed, you can ask for a Medicaid Fair Hearing. A Medicaid Fair Hearing lets a judge who is not part of Molina Healthcare review your case.
You may be able to keep your services while the state reviews your case.
To ask about this, call SMMC Medicaid Member Services at (866) 472-4585 (TTY: 711), Monday through Friday, 8a.m. –7p.m. local time.
Important timeframes
You only have 120 days to ask for a Medicaid Fair Hearing.
Cost
You do not have to pay for a Medicaid State Fair Hearing.
You can read more about these rights in your Member Handbook.
External review for Title 21 (KidCare)
If your child has Title 21 (KidCare) and you do not agree with our Plan Appeal decision, you can ask for an outside review. An Independent Review Organization (IRO) will do the review. The IRO is not part of CMS. It will look at your child’s case and make a decision.
You must ask for an outside review by the date in your Notice of Plan Appeal Resolution letter. To ask for an outside review, follow the steps in your letter. Or contact us at:
Children’s Medical Services (CMS) Plan by Molina Healthcare
P.O. Box 36030
Louisville, KY 40233-6030
Phone: (800) 262-0750 (TTY: 711)>
Fax: (877) 508-5748
Email: mflgrievanceandappealsdepartment@molinahealthcare.com
If your child’s services kept going during the appeal, and if you ask for a review on time, your services may keep going until a decision is made. Some rules may apply. The IRO makes the final decision.
Molina Healthcare is a Managed Care Plan with a Florida Medicaid Contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the Managed Care Plan. Limitations and/or restrictions may apply. Benefits may change. Molina Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. For SMMC Medicaid (Service Area Region I Counties: Miami-Dade, Monroe) language assistance services call (866) 472-4585 (TTY: 711) Monday–Friday, 8:00 a.m. - 7:00 p.m. For CMS Plan language assistance services call (800) 262-0750 (TTY: 711) Monday–Friday, 8:00 a.m. - 7:00 p.m. local time. For SMMC Medicaid and CMS Plan enrollment, call Choice Counseling at (877) 711-3662 / TDD: (866) 467-4970 Monday – Thursday, 8:00 a.m. – 8:00 p.m., Friday 8:00 a.m. – 7:00 p.m. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. For SMMC Medicaid call (866) 472-4585 (TTY: 711). For CMS Plan call (800) 262-0750 (TTY: 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Para SMMC Medicaid llame al (866) 472-4585 (TTY: 711). Para CMS Plan llame al (800) 262-0750 (TTY: 711). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Pou SMMC Medicaid rele (866) 472-4585 (TTY: 711). Pou CMS Plan rele (800) 262-0750 (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Đối với SMMC Medicaid gọi (866) 472-4585 (TTY: 711). Đối với CMS Plan gọi (800) 262-0750 (TTY: 711).