The Office of Waiver Appeals, located within the Alabama Department of Mental Health’s Division of Developmental Disabilities, provides an opportunity for individuals with intellectual disabilities either applying to or enrolled in one of Alabama’s Home and Community-Based Services (HCBS) waiver programs to exercise their right to appeal. These waiver programs include the Intellectual Disabilities (ID) waiver, the Living at Home (LAH) waiver, and the Community Waiver Program (CWP).
What can be appealed?
- Denial of eligibility for enrollment into any of the three waiver programs (ID/LAH, CWP)
- Any Adverse Action related to services delivered in the HCBS waiver programs (ID/LH/CWP), including:
- Denial of services of choice within the waiver programs
- Denial provider of choice within the waiver programs
- If an individual’s services have been suspended, reduced, terminated, or delayed.
How to appeal:
Appeals must be submitted in writing, addressed to the ADMH-DD Associate Commissioner, and received within 15 calendar days of the effective date listed on the denial notification. Upon review of the appeal request, communication, and requests of supporting documents from the applicant and/or their representative, informal conference procedures where applicable, and subsequent decision from the DD Associate Commissioner, a written notice will be mailed to the individual and/or their representative the original denial is to be upheld or reversed. If the decision is to uphold the denial and the individual disagrees with this decision, they can request a Fair Hearing from the Alabama Medicaid Office. More information on the process for requesting a Medicaid Fair Hearing can be found in the accompanying documents on this page.
The Office of Waiver Appeals also maintains and tracks data related to an individual’s complaints and grievances about services offered within the division. Complaints and grievances are logged and sent to the appropriate staff for review and resolution.