External reviews in Michigan

If you or an authorized representative asked for an appeal and got a resolution letter saying our decision stayed the same — and you do not agree — you have the right to ask for an external appeal. You or an authorized representative can also ask for an external appeal, if you asked for an appeal but did not get a resolution letter, and more than 30 days have passed since you filed your appeal.

You may also be able to ask for a State Fair Hearing.

External Appeals are free.

You may be able to have your services continue while your case is reviewed. To ask for continued services, call Molina Member Services at  (888) 898-7969, Monday through Friday, 8:00 a.m. to 5:00 p.m. local time.

State Fair Hearing

A State Fair Hearing lets a judge who is not part of Molina Healthcare review your case.

You must ask for a State Fair Hearing within 120 days from the date on the letter telling you the appeal decision. The judge’s decision is final, and we must follow it.

If waiting for a State Hearing could harm your life, health, or ability to function, you, your provider, or your authorized representative can ask the Michigan Department of Health and Human Services (MDHHS) for a fast (expedited) hearing. MDHHS must make a decision no later than 3 business days after getting your complete case file from Molina Healthcare.

You can read more in your Member Handbook.

How can you ask for a State Fair Hearing?

You can file a State Fair Hearing in different ways

• Online: Visit Michigan.gov/mdhhs/assistance-programs/medicaid/hearings
• Phone: Call  (800) 648-3397 (TTY, 711)
• Mail: Fill out the form that came with your appeal resolution letter and send it to:
  Michigan Department of Health and Human Services
  Michigan Office of Administrative Hearings and Rules
  P.O. Box 30763
  Lansing, MI 48909
  Attn: Hearings/Appeals

If you need help asking for a State Hearing, we can help. We offer no-cost language services. Call Molina Member Services at (888) 898-7969, Monday through Friday, 8:00 a.m. to 5:00 p.m. local time.

External Review

An External Review lets an independent doctor who is not part of Molina Healthcare review your case. Their decision is final, and we must follow it.

You must ask for an External Review within 6 months from the date on the letter telling you the original appeal decision.

You can read more in your Member Handbook. 

How can you ask for an External Review?

You can call the Michigan Department of Health and Human Services (MDHHS)to ask for an External Review.

• Online: https://difs.state.mi.us/Complaints/ExternalReview.aspx
• Fax: (517) 284-8848
• Mail your request to:
  Department of Insurance and Financial Services (DIFS),
  Healthcare Appeals Section, Office of General Counsel,
  P.O. Box 30220,
  Lansing, MI 48909-7720.

If you need help asking for an External Review we can help. We offer no-cost language services. Call Molina Member Services at (888) 898-7969, Monday through Friday, 8:00 a.m. to 5:00 p.m. local time.

Important Timeframes

You must ask for an External Review within 6 months from the date on the letter telling you the appeal decision.

You only have 120 days to ask for a State Fair Hearing.

If you want both a State Hearing and an External Review, ask as soon as you can.

Important:

If you first ask for a State Fair Hearing and the hearing already happened, you cannot ask for an External Review. In that situation, the State Fair Hearing decision is final.

Cost

You do not have to pay for a State Fair Hearing or an External Review.

You can read more about these rights in your Member Handbook.