AHCCCS

Arizona Department of Economic Security (DES) Appeal

The Arizona Health Care Cost Containment System (“AHCCCS”) is Arizona’s Medicaid agency that offers health care programs to serve residents that meet certain eligibility requirements.  An individual who is denied benefits or services by AHCCCS or the Arizona Department of Economic Security (“DES”) has the right to an appeal.

Any individual who has received a Notice of Adverse Action by AHCCCS may request an appeal.  The requirements for an appeal of an eligibility determination is slightly different than the appeal procedure for a person enrolled with an AHCCCS contractor, therefore, it is important to recognize the variances.  An adverse action is defined as:

  • Denial of eligibility
  • Discontinuance of eligibility
  • Increase in the share of Arizona Long Term Care costs
  • Increase in premiums or copayments
  • Failure by AHCCCS to make a determination within the established timeframe

Once the Notice of Adverse Action has been received the applicant must request a State Fair Hearing (“Hearing”) in writing with AHCCCS within 30 days.  The request for a Hearing must contain the case name, the adverse action taken by AHCCCS and the basis for the Hearing.

If AHCCCS receives a request for Hearing that is timely and contains the necessary information a Notice of Hearing will be mailed to the applicant.  The Hearing normally will be held between 30-60 days from the date the applicant requests a Hearing.

AHCCCS may deny the request for Hearing if the request for Hearing is:

  • Not sent within 30 days
  • Not for an adverse action
  • Already decided
  • A decision that would affect/change the coverage for current members or applicants

AHCCCS shall mail the resolution of the hearing to the applicant no later than 30 days after the Hearing and within 90 days from the date the applicant filed a request for Hearing.

If you have been denied benefits by the Arizona Department of Economic Security and would like to appeal contact Attorney Robert Chelle.