Medicaid Complaints and Appeals

What should I do if I have a complaint?

We want to help. If you have a complaint, please call us toll-free at 1-855-691-6262 to speak to a Member Advocate.

You can also submit your complaint in writing to:

Can someone help me file my complaint?

Yes! An MCNA Member Advocate can help you file your complaint. Most of the time we can help you right away. Call 1-855-691-6262 to talk to an MCNA Member Advocate about your complaint. You may call at any time during the complaint process to check the status of your complaint.

Can I file a complaint with anyone else?

If you wish to file a complaint after going through MCNA’s process, you may file a complaint with the Texas Health and Human Services Commission by phone at 1-800-252-8263, or by mail at:

What should I do if I have an appeal?

If you are not happy with MCNA’s decision to deny or limit services requested by your dentist, please call us toll-free at 1-855-691-6262 to speak to a Member Advocate. When you call we will explain what happens during the appeal process and tell you how to write your appeal and send it to us. We will also send you any forms you may need to complete your appeal.

If you call to ask for an appeal, you must also write out and sign your appeal and send it to MCNA.

You can send your written appeal to:

Can someone help me file my appeal?

Yes! An MCNA Member Advocate can help you file your appeal. Most of the time we can help you right away. Call the MCNA Member Hotline at 1-855-691-6262 to ask a Member Advocate for help filing an appeal. You may call the Member Hotline at any time during the appeal process to check the status of your appeal.

How quickly are appeals resolved?

Standard appeals are resolved within 30 days.

You can ask for an emergency appeal when you don’t have time to wait for a standard appeal, such as when your child’s life or health is in danger. Emergency appeals are resolved within 3 days. If MCNA decides your appeal does not meet the requirements to be expedited, your appeal will go through the standard appeal process.

Our Member Advocates will guide you through this process.

What if I’m still not happy?

You have the right to ask for a State Fair Hearing. You must first exhaust MCNA’s appeal process. In a State Fair Hearing, you may name someone to represent you (such as a doctor or other medical provider). You must ask for a State Fair Hearing within 120 days of the date on the original decision letter from MCNA. To make a request, you may write a letter that includes the name of your representative and send it to:

You can also ask for a State Fair Hearing by calling MCNA toll-free at 1-855-691-6262. Call this number at any time to ask questions or check the status of a State Fair Hearing. If you call to ask for a State Fair Hearing, you must also write out your request, sign it, and send it to MCNA.

Once you ask for the State Fair Hearing, you will get a packet of information letting you know the date, time and location of the hearing. Most State Fair Hearings are held by telephone. The Texas Health and Human Services Commission will give you a final decision within 90 days from the hearing.

Where can I find forms to use for a complaint or appeal?

You can download and print a Complaint Form or Appeal Form. Learn more about Medicaid complaints and appeals in your Member Handbook. You will also find more information about the State Fair Hearing process.