A letter arrives from the county. Your family member was turned down for the CADI waiver, or the hours they rely on are being cut, or a service is ending. The letter is full of legal citations, and the date that matters is easy to miss.
You can challenge the decision, and you don't need a lawyer or a special form to start. But the first 10 days matter more than most families realize.
The rules below come from Minnesota Statutes § 256.045, Minnesota DHS's Community-Based Services Manual, DHS's own notice form and federal Medicaid rules. Program rules change, and the notice you received controls. Confirm the details with your county or tribal nation, and talk to a legal aid office if a lot is at stake. This guide is general information, not legal advice.
The two deadlines
Most guides mention one deadline. There are really two, and they do different jobs.
- About 10 days after you receive the notice, and before the effective date printed on it: this protects your chance to ask that services stay the same while the appeal is decided.
- 30 days after you receive the notice: this protects your right to appeal at all.
The 30-day limit is in Minn. Stat. § 256.045, subd. 3. It can stretch to 90 days if you show good cause for being late, but you carry the burden of proving that.
The shorter window comes from the state's notice form, which says a request to keep services the same must usually arrive no later than 10 days after you get the notice. Federal rules say a hearing requested before the date of the action generally stops the agency from ending or reducing services until the decision. The two are worded differently, so the safe approach is to meet both: file before the effective date and within 10 days of getting the letter. Count from the date printed on the notice, so you have a margin.
If you appeal on day 25, you can still win. But the cut may already have happened.
Step 1: Read the notice for four things
The county must explain itself in writing. DHS's manual says a notice of action has to give the reason, including the legal basis, the timeline, and how to appeal, including the right to ask that services continue. Find:
- The effective date. For most denials, reductions and terminations, the county must send the notice at least 10 days ahead of it. If a person no longer meets nursing facility level of care, the manual requires at least 30 days.
- The reason box. Waiver denial reasons on the state's form include financial eligibility, disability certification, level of care, and that the person's needs can be met without a waiver service.
- The written explanation. DHS requires it in plain language with clear details about why the county acted. If yours is vague, ask the case manager to explain it and to put the answer in writing.
- The appeal section. It tells you where to send your request.
Check which word the notice uses, because they mean different things. A denial is about something the person isn't getting yet. A reduction or termination affects something they already have, and only those can be "kept the same" during an appeal.
Step 2: Call the case manager, but don't wait on the call
Sometimes the problem is fixable: a missing document, an assessment that left something out, or a need that has changed. Ask what would have to be different for the decision to change, and whether a reassessment makes sense. Our guide to what a CADI case manager does explains what you can ask of them, and our guide to the MnCHOICES assessment covers how needs get recorded.
A friendly conversation does not pause the clock. File the appeal anyway. You can have the conversation while it's pending.
Step 3: File the appeal in writing
According to the state's notice form, there is no special form required, and a short letter is fine. Put in:
- the person's name and the date on the notice;
- what you are appealing;
- why you think it's wrong;
- if services are being cut or ended, one clear sentence: "I request that services stay the same until the appeal is decided."
You can use the online Appeal to State Agency form (DHS-0033), or send your request with a copy of the notice to:
Minnesota Department of Human Services, Appeals Division, P.O. Box 64941, St. Paul, MN 55164-0941. Fax: 651-431-7523. Phone: 651-431-3600.
One detail matters here. The form allows the appeal itself to go to your assessor or case manager, but it says a request to keep services the same must go to the appeals unit. Send it there directly. Keep a copy, and keep proof of when you sent it.
If the decision came from a health plan rather than the county or tribe, the plan has its own appeal process and deadlines. Check the notice.
The risk to know before asking to keep services
Keeping services during an appeal is not free of risk. The state's form warns that if you keep the same services and lose, the state may bill you for the difference. Federal rules allow that kind of recovery too.
For many families, keeping care in place is still the right call. But make it knowingly, and ask legal aid about your situation if the amounts could be large.
When an appeal may not help
We'd rather tell you this now than have you find out at a hearing.
- If the change comes from a new law or policy that applies to everyone, DHS's manual says the county doesn't have to send a notice of action, because appeal rights don't apply to legislative changes. And under federal rules, services can be cut before the decision if the only issue at the hearing is law or policy.
- If the person really doesn't meet an eligibility rule, such as the level-of-care requirement in our CADI eligibility guide, the better path may be to fix that gap or ask about other programs. You can file a new application at any time, even during an appeal.
- If the problem is the provider, not the county, that's a different process. See how to change waiver providers.
What the hearing is like
From DHS's hearing FAQ, which is an older document, so confirm anything critical:
- A human services judge runs it. Most hearings are held by phone, and they are private.
- You can see the case file beforehand and get free copies of papers related to the hearing. Do this. The agency can't use information it didn't give you a chance to see.
- You can bring a friend, relative, advocate or lawyer. Interpreters are provided at no charge.
- Bring evidence: letters from doctors, therapists or teachers, a log of the help the person actually needs, and the previous support plan.
- If you can't attend, call the judge right away. Missing a hearing normally means losing the appeal.
DHS says a decision can take up to 90 days, and LawHelpMN notes it often takes longer. If you lose, you have 30 days from the date on the appeal decision to ask the state in writing to reconsider, or you can appeal to district court. On the DD waiver, a person can also ask the county for a conciliation conference, an informal meeting the county schedules to try to resolve the disagreement (Minn. Stat. § 256.045, subd. 4a).
Free help
- Minnesota Disability Law Center (part of Mid-Minnesota Legal Aid): 1-800-292-4150. Free legal help for people with disabilities.
- Office of Ombudsman for Mental Health and Developmental Disabilities: 651-757-1800 or 1-800-657-3506. Help with complaints about services and treatment.
Call early. These offices can't help as much once a deadline has passed.
Where Midway Homes fits
We're a service provider. We don't make waiver decisions, and we can't represent you at a hearing. But we work with support plans and case managers every day, and we're glad to help you make sense of a notice and work out who to call. If services are approved and you're looking for a provider, our questions to ask a 245D provider can help you compare.
Midway Homes Adult Care LLC is a Minnesota 245D-licensed provider serving Ramsey, Hennepin, Dakota, Scott, Washington, Chisago and Pine counties. Call 612-416-8555. If we're not the right fit, we'll tell you.