Right to Appeal Denial of Benefits
If you have been denied benefits and disagree with this decision, you may ask for an appeal. Contact your worker at the Department of Social Services who sent the letter denying benefits.
Right to Appeal Denial of a Specific Service
If a Medicaid health service is denied (or if it is reduced, terminated, or suspended), you will receive a letter that describes the decision and why it was made.
The letter has instructions for how to appeal. Please sign the required forms to accept delivery of the letter. The letter will come from the Division of Medical Assistance or one of its vendors, including:
- The Carolinas Center for Medical Excellence
- The Murdoch Center
- A behavioral health LME-MCO
The Appeals Unit, Division of Medical Assistance
The Office of Administrative Hearings
Medicaid recipients are entitled to have their medical information be kept private.
Children's Right to Medically Necessary Health Care
A federal law requires Medicaid to provide all medically necessary health care services to Medicaid-eligible children. This is called Early and Periodic Screening, Diagnosis and Treatment (EPSDT), or Health Check. The services are required even if the services are not normally covered by children's Medicaid.
Medical Care Decisions and Advance Directives
If you are 18 or older and able to communicate and make health care decisions, you have the right to make decisions about your medical and mental health treatment.
If you are a Community Care of North Carolina/Carolina ACCESS (CCNC/CA) member, you have a right to make a complaint if you think your primary care doctor has not provided good care. To file a complaint, follow the instructions on the Carolina ACCESS Complaint Form.
HIPAA Privacy and Security Rules
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 includes a Privacy Rule, which protects individual health information while allowing disclosure needed for patient care and other important purposes. The Security Rule specifies safeguards for businesses to use to ensure the confidentiality and integrity of electronic protected health information. HIPAA Companion Guides are available under NCTracks.