External appeal reviews in Ohio

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. This is called a state hearing. 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.

State hearing

A state hearing lets a judge who is not part of Molina Healthcare review your case.

You must ask for a state hearing within 90 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 Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings for a fast (expedited) hearing. ODJFS must make a decision no later than 3 business days after getting your complete case file from Molina Healthcare.

How can you ask for a state hearing?

You can request a state hearing online or by fax, phone or mail.

• Online: Visit ODJFS Bureau of State Hearings
• Fax: Fill out the form that came with your appeal resolution letter and fax it to (614) 728-9574
• Phone: Call the ODJFS Bureau of State Hearings at (866) 635-3748 (TTY:711)
• Mail: Fill out the form that came with your appeal resolution letter and send it to:
  ODJFS Bureau of State Hearings
  P.O. Box 182825
  Columbus, Ohio 43218-2825

If you need help asking for a state hearing, we can help. We offer no-cost language services. Call Molina Member Services at the number on your ID card.

Important timeframes

You must ask for a state hearing within 90 days of getting the letter telling you the appeal decision.

Cost

You do not have to pay for a state hearing.