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Frequently Asked Questions (FAQs)

How do I appeal an eligibility decision I disagree with?

If you do not agree with our decision about your health insurance coverage or assistance, you have a right to appeal our decision and receive a Fair Hearing. You can appeal a denial, termination, or change in your eligibility for Medicaid, premium tax credits, or cost-sharing assistance. You can also appeal if you disagree with the amount of your premium tax credits or cost-sharing assistance. Once you appeal, you can go before an Administrative Law Judge and explain why you do not agree with our decision.

You have 90 days following the postmark of the notice informing you of the eligibility decision, denial, termination, or change, to appeal the decision stated in the notice you received. If you do not appeal within 90 days, you may lose your appeal right.

You may appeal through any of the following methods:

Office of Administrative Review and Appeals
64 New York Avenue NE, 5th Floor
Washington DC 20002

  • Going to any Department of Human Services Service Center (locations found at dhs.dc.gov) and filling out the Appeal Request Form.

  • Going to the Office of Administrative Hearings Resource Center, located at 441 4th Street NW, Suite 450-North, Washington, DC 20001 and filling out the Appeal Request Form.

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