Medicaid members have the right to appeal decisions made about a service request. Everyone, including recipients of State-funded services, has the right to voice a concern, complaint or grievance. Please review the Member & Recipient Handbook, Section 10, for more information.
The Medicaid member (or their authorized representative) who does not agree with Trillium’s Adverse Benefit Determination decision is eligible to go through the Trillium Reconsideration Process. This is guaranteed under the North Carolina Mental Health/Developmental Disabilities/Substance Abuse Services Health Plan 1915(b) and NC Innovations Home & Community Based Waiver 1915(c).
You must first go through the Trillium Reconsideration process before using the State Fair Hearing process. Reconsiderations are decided by health care professionals with appropriate clinical expertise in treating your condition or disorder.
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