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File an appeal: Apple Health (Medicaid)
Apple Health (Medicaid) providers, applicants, and recipients may appeal HCA decisions in certain circumstances. They do this by requesting an administrative hearing.
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When does a provider have a right to a hearing?
You may have a right to a hearing--as identified in your notice or remittance advice--if you are a provider assessed with an over payment under RCW 41.05A.170.
An administrative law judge at the Office of Administrative Hearings (OAH) will conduct a hearing either by telephone or in person, and then issue an initial order.
Providers may request review of the initial order from the Board of Appeals, which will issue a final order.
The Health Care Authority and our partner, the Department of Social and Health Services (DSHS), make eligibility and coverage determinations for Medicaid Titles XIX and XXI of the Social Security Act.
When does an applicant or recipient have a right to a hearing?
If you have received a letter from Apple Health and are aggrieved by a decision, you may have a right to a hearing. Follow the directions on your letter and complete any form that came with your letter to request a hearing.
Or you can contact the Office of Administrative Hearings (OAH) at 800-583-8271.
An administrative law judge at OAH will conduct a hearing either by telephone or in person, and then issue an initial order.
Applicants and recipients may request review of the initial order from the Board of Appeals, which will issue a final order.
To request an administrative hearing, or if you want an interpreter or other help to request a hearing:
- Complete any form that came with your letter and fax to 1-360-586-9080.
- Call 1-855-923-4633 or 1-800-562-3022.
If you are low-income, Coordinated Legal Education Advice and Referral (CLEAR) may help you find free legal assistance. Apply online or:
- If under age 60, call 1-888-201-1014.
- If age 60 or over, call 1-888-387-7111.
Washingtonlawhelp.org lists information and resources about our administrative hearings.