Medicaid appeal process and deeming-period coverage
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Explains appeal rights for Wellcare Meridian Dual Align (HMO D-SNP) members in Michigan and describes a change to how Michigan Medicaid benefits are handled during the 3-month deeming period for members who lose Medicaid eligibility.
Clarifies that members cannot request an external review from Michigan DIFS when the plan denies an appeal for a Medicaid service but may request a State Fair Hearing (Level 2 appeal).
Starting July 1, 2026, the plan will not pay for Michigan Medicaid benefits during the deeming period, though it will continue Medicare benefits and Medicare cost-shares the plan covers.
Deeming-Period Medicaid Coverage Rules
Deeming-period Medicaid coverage
Deeming-period coverage rules for members who lose Michigan Medicaid:
Appeals and Escalation — Provider / Member Actions
Medicaid appeal routing — no DIFS external review; State Fair Hearing allowed
Members cannot request an external review from the Michigan Department of Insurance and Financial Services (DIFS) when the plan denies an appeal for a Medicaid service; however, members may request a State Fair Hearing (Level 2 appeal) with the State of Michigan.
- You cannot ask the Michigan Department of Insurance and Financial Services (DIFS) for an external review when the plan denies an appeal for a Medicaid service.
- You can still ask for a Fair Hearing with the State of Michigan (Level 2 appeal) if the plan denies your appeal for a Medicaid service.
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