If you do not agree with DC Health Link’s decision about your health insurance coverage or assistance in paying for coverage, you have a right to appeal the decision and receive a hearing before an independent administrative law judge. You can appeal a coverage denial, termination, or a change in your eligibility for Medicaid, as well as your eligibility for premium tax credits, cost-sharing assistance, or for an enrollment period. You can also appeal if you disagree with the amount of your premium tax credits or cost-sharing assistance you have been told you are eligible to receive. 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 request an appeal by doing any of the following:
Details on your appeal rights, what will happen during the appeal process, and organizations that may be able to represent you during the appeal process are available on the DC Health Link website. You can also find additional FAQs on the appeal process available here.