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File An Appeal

Applicants or recipients of Medicaid who are dissatisfied with a decision made by the county agency or the North Dakota Department of Human Services, or who have not had their application acted on with reasonable promptness, may appeal to the North Dakota Department of Human Services.

To File an Appeal:

  1. An appeal can be filed verbally over the phone, or in written format by email, fax or mail.
  2. A request to appeal must be filed no later than 30 days from the date the notice of action is mailed.
  3. You can use  SFN 162: Request for Hearing to file the appeal but it is not required.
  4. You are not required to sign SFN 162: Request for Hearing to submit the appeal request.
  5. If you do not use SFN 162: Request for Hearing, please provide your name, contact information, and program decision or error that you are appealing.
Hyperlink Button to submit an appeal online Click this button to submit an appeal request online

Contact Information

Appeals Supervisor, Legal Advisory Unit
N.D. Department of Human Services
600 E Boulevard Avenue, Dept. 325
Bismarck, ND 58505-0250
Phone: (701) 328-2311
Toll Free: (800) 472-2622
711 (TTY)
FAX: (701) 328-2173
Email: dhslau@nd.gov

Nondiscrimination Policy and Related Information

Client Rights and Appeals

Language Assistance and Auxiliary Aids and Services are available at no cost.

 
Spanish - Español (22kb pdf) Bantu - Uncedo - Ukusiza - Kusaidia (17kb pdf) Nepali - नेपाली (67kb pdf)
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Chinese - 中文 (22kb pdf) Swahili (22kb pdf) Korean - 한국의 (66kb pdf)
Cushite - Kusitiese (16kb pdf) Russian - Pусский (105kb pdf) Tagalog (17kb pdf)
Vietnamese - Tiếng Việt (70kb pdf) Japanese - 日本の (58kb pdf) Norwegian - Norsk (22kb pdf)

 

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