State Fair Hearing
Members have the right to ask for a Fair Hearing if they disagree with a decision made by Molina Healthcare. A State Fair Hearing can be requested after you complete Molina Healthcare's appeal process. A State Fair Hearing must be requested wtihin 120 days from the date on the Appeal Resolution letter from Molina Healthcare. If a State Fair Hearing is not requested within 120 days, rights to a State Fair Hearing may be lost. To request a State Fair Hearing the member or member's representative must contact Molina Healthcare in writing or by telephone at:
Molina Healthcare of Texas
PO Box 165089
Irving Texas 75016
Attention: Member Resolution Team
Fax (877) 816-6416
Phone (866) 449-6849
TTY (800) 662-4954
Members who requested and received continued services during the appeal process have the right to continue any service being received until the final hearing decision. To continue receiving services during the State Fair Hearing, the Member must request a State Fair Hearing within ten (10) business days of the date on the Appeal Resolution letter from Molina Healthcare. If a State Fair Hearing is not filed within ten (10) business days, the services being appealed will be discontinued.
If a State Fair Hearing is requested, a packet of information with the date, time and location of the Hearing will be sent to the member. Members may write or call toll-free at any time during the appeals process (866) 449-6849.
Most State Fair Hearings are held by telephone and the member or member representative will be able to discuss the services being appealed.
Members can bring someone who knows about the case to attend the hearing. Members may also bring someone else to represent them. This person can be a doctor, a friend or a relative.
The Texas Health and Human Services Commission will make a final decision within 90 days from the date that the Hearing was requested.