State Fair Hearings

If you've finished the appeals process and you’re not happy with the outcome, you may request a state fair hearing.

You must request your state fair hearing within 120 days of getting notice of the appeal decision.

How do you request a state fair hearing?

You must complete the AmeriHealth Caritas Delaware appeals process before filing a state fair hearing. You, a personal representative, or a provider you choose to assist you can file your request. If you want a personal representative or provider to speak on your behalf at the hearing, you must give that person or provider written permission.

Request a state fair hearing with the Delaware Division of Medicaid & Medical Assistance (DMMA) by:

  • Calling: 1-302-255-9500 or 1-800-372-2022
  • Writing to:

Division of Medicaid & Medical Assistance (DMMA)
Fair Hearing Officer
1901 North DuPont Highway
P.O. Box 906, Lewis Building
New Castle, DE 19720

Continuing benefits during an appeal and/or state fair hearing

You can keep getting covered services while you wait for us to decide on an appeal or while a state fair hearing is pending if all of the following apply:

  • The appeal is filed on or before the later of:
    • 10 days from the date we mailed the adverse benefit determination.
    • Before the effective date on the adverse benefit determination.
  • The appeal is related to:
    • Reduced or suspended services.
    • Services that were previously authorized for you.
  • The services were ordered by an authorized provider.
  • The authorization period for the services has not ended.
  • You asked that the services continue.

If AmeriHealth Caritas Delaware continues your benefits while deciding an appeal or while a state fair hearing is pending, the services must be continued until one of the following happens:

  • You decide not to continue the appeal.
  • You do not request a state fair hearing within 10 days from the date we mail the adverse benefit determination.
  • The authorization for services expires or authorization service limits are met.
  • A hearing decision is issued in the state fair hearing that is adverse to the member.

If the state fair hearing officer agrees with you, we will pay for the services you got while you waited for the decision. However, if the state supports the original appeal decision and rules against you, you will have to pay for the service you received during the waiting period.

Members