Independent medical reviews in New York
Learn about your rights to file an external appeal.
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 can 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 Call Molina Healthcare of New York and Affinity by Molina Healthcare Member Services at (800) 223-7242 (TTY/TDD: 711) Monday - Friday 8 a.m. - 6 p.m. local time. Call Senior Whole Health of New York NHC Medicaid Advantage Plan (MAP) (833) 671-0440 (TTY: 711) Monday - Friday 8 a.m. - 8 p.m. local time. Call Senior Whole Health of New York Managed Long-Term Care (MLTC) (877) 353-0185 (TTY: 711) Monday - Friday 8 a.m. - 8 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 60 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 New York Office of Administrative Hearings for a fast (expedited) hearing. They 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:
Read your Molina New York Member Handbook.
Read your Affinity by Molina Healthcare Member Handbook.
Read your Medicare Member Handbook.
How can you ask for a State Fair Hearing?
You can file a State Fair Hearing in different ways
Online: Visit http://otda.ny.gov/oah/FHReq.asp/FHReq.asp
Phone: Call (800) 342-3334, TTY/TDD: (800) 662-1220 or 711
Fax: Fill out the form that came with your appeal resolution letter and fax it to (518) 473-6735
Mail: Fill out the form that came with your appeal resolution letter and send it to:
New York State Office of Temporary and Disability Assistance
Office of Administrative Hearings
Managed Care Hearing
Unit P.O. Box 22023
Albany, NY 12201-2023
If you need help asking for a State Hearing, we can help. We offer no-cost language services. Call Molina Healthcare of New York and Affinity by Molina Healthcare Member Services at (800) 223-7242 (TTY/TDD: 711) Monday - Friday 8 a.m. - 6 p.m. local time. Call Senior Whole Health of New York NHC Medicaid Advantage Plan (MAP) (833) 671-0440 (TTY: 711) Monday - Friday 8 a.m. - 8 p.m. local time. Call Senior Whole Health of New York Managed Long-Term Care (MLTC) (877) 353-0185 (TTY: 711) Monday - Friday 8 a.m. - 8 p.m. local time.
Contact Member Services at the links below:
Medicaid: molinahealthcare.com/medicaid/ny/contact Medicare: molinahealthcare.com/medicare/ny/contact
Important Timeframes
You must ask for a State Fair Hearing within 60 days of when you get the letter telling you the appeal decision.
Cost
You do not have to pay for a State Fair Hearing.
You can read more about these rights in your Member Handbook.