Your Rights

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. 

NC Health Choice Recipients 1st and 2nd Level Reviews

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:

  • ACS
  • CSRA
  • The Carolinas Center for Medical Excellence
  • MedSolutions
  • The Murdoch Center
  • ValueOptions
  • A behavioral health LME-MCO

The Appeals Unit, Division of Medical Assistance

Phone: 919-855-4260 

The Office of Administrative Hearings
Phone: 919-431-3000

More information on Your Due Process Rights

An Overview of Due Process

Grievance and Appeal System: 42 CFR, Subpart F

Privacy

Medicaid recipients are entitled to have their medical information be kept private.

Children's Right to Medically Necessary Health Care

Medicaid offers broad healthcare coverage for children and adolescents, addressing their unique needs. Known as Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT), this benefit package offers comprehensive medical, dental and behavioral health treatment services, as well as regular preventive care through the Health Check program.

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.

Medical Care Decisions and Advance Directives

Complaints

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.