How to Appeal a Denial or Reduced Hours in Michigan’s Home Help Program
If you’ve received a denial letter or were approved for fewer hours than expected through Michigan’s Medicaid Home Help Program, you have the right to appeal the decision. This guide walks you through each step of the process and what to expect along the way.
🚫 Why Was the Application Denied or Reduced?
There are several reasons why Home Help applications may be denied or approved for less than expected:
Missing or incomplete forms (like the DHS-54A Medical Needs form)
Insufficient medical justification from a healthcare provider
The Adult Services Worker (ASW) assessment didn’t reflect significant need
Ineligibility due to Medicaid status
The individual needing care did not meet the criteria for help with Activities of Daily Living (ADLs)
Understanding the reason for the denial is the first step toward correcting it.
🧾 Step 1: Read the Notice Carefully
You should receive a Notice of Case Action (DHS-176 form). This document explains:
The reason for the denial or reduction
Which ADLs were not approved
Instructions on how and when to appeal
Appeals generally must be filed within 90 days of the date on the notice.
✍️ Step 2: Request a Hearing
To appeal, you need to complete the Request for Hearing (Form DCH-0092).
You can:
Download the form at michigan.gov/mdhhs
Visit your local MDHHS office
Ask your ASW for a copy
The completed form can be mailed or faxed to the address listed on the back of your denial notice.
📞 Step 3: Gather Supporting Documentation
Before the hearing, it’s a good idea to collect or update documents that support your case. These may include:
A new or updated DHS-54A Medical Needs form from your doctor
Letters or statements from medical professionals describing the recipient’s needs
Detailed notes about the care provided and the challenges faced daily
Any new hospital records, diagnoses, or medication changes since the last review
Be prepared to clearly explain why additional hours are needed or why the denial was incorrect.
📅 Step 4: Prepare for the Hearing
The hearing will likely be conducted by phone with an Administrative Law Judge (ALJ). During the hearing:
You'll be asked questions about your application and daily care needs
You can present the new documentation you've gathered
You may bring someone with you for support or clarification
The hearing is your opportunity to explain your situation clearly and factually.
⏳ Step 5: Continue Services During Appeal (If Applicable)
If your services are being reduced (not fully denied), and you wish to keep receiving the previously approved hours during the appeal process, you must request benefits continue within 10 days of the denial notice. This request must be made in writing and submitted along with the appeal.
📬 Step 6: Wait for the Decision
After the hearing:
The ALJ will review all submitted materials
A written decision will be mailed to you
If the decision is in your favor, services may be restored or increased
If denied, you may still have options such as submitting a new application with stronger medical documentation
📝 Final Tip
The most important part of the appeal process is preparation. Be thorough, stay organized, and respond quickly to all deadlines. The more clearly and accurately you can present the daily needs of the person receiving care, the better your chances of success.