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Grievance and Appeal Contacts for Managed Long Term Care Plans

BEGINNING MARCH 1, 2018, members of Medicaid managed care and Managed Long Term Care plans will be required to request an INTERNAL APPEAL within their plan, and wait until the plan decides that appeal, before they may request a FAIR HEARING.  This is called the "exhaustion" requirement" and is required by federal regulations. Read more about this change here -  Heads Up - Changes Coming in Fair Hearing Rights for MLTC and Managed Care Members - March 2018

On this webpage, we will post the contact information for members to request internal appeals in MLTC plans.  This will include phone, e-mail, fax, and regular mail addresses.   All of this information should be in the plan's member handbook,  but as of Jan. 29, 2018, the State still  has not revised the language in the member's handbook describing the appeal process.  Therefore the member handbooks posted on plan websites - some links in table below - do NOT now have the updated information.  Mebers should be receiving revised handbooks by mail before March 1, 2018.      We will be posting links to revised member handbooks in the chart  when available  (Please e-mail us a PDF of your plan's member handbook if you don't see it in our chart!)  

An enrollee must  use either the plan's appeal or grievance procedures depending on the type of problem presented. 

  • A grievance is an expression of dissatisfaction with the plan. For example, an aide came late,  the enrollee was treated rudely or was not called back, a request for services hasn't been processed or responded to. A grievance is not about the scope, amount or type of service that was approved by the plan.

  • An Internal Appeal is a request for a review of an action taken by a plan.  If the MLTC plan denies, reduces, or ends services that the enrollee believes she should have, she has the right to appeal.   For example, the plan reduces personal care services from 12 to 8 hours/day, or denies your request to participate in the Consumer-Directed Personal Assistance Program (CDPAP).  Beginning March 1, 2018, the member MUST request this internal appeal first and wait until it is decided by the paln BEFORE requesting a Fair Hearing.

An overview of Grievances and Appeal rights is available in this article linked here.   


State Complaint Number for MLTC Problems - 1-866-712-7197 

  • e-mail mltcworkgroup@health.state.ny.us and put "COMPLAINT" in subject line

  • For enrollment complaints - call NY Medicaid Choice -
    •  1-855-886-0570 (Advocates line)
    •  1-888-401-6582 (Consumers line) 

1.  MLTC Plans Information on Appeals or Grievances  -


Appeals & Grievance  Information 

NOT UPDATED as of 1/29/18

Mail/ in-person

Address to Request Appeals

Phone/Fax/Email to Request     Appeal (only Centers Plan updated as of 1/29/18)
Aetna Better Health

Appeal info  here.

Member handbook  here.


Appeal  info  here.

Member handbook   here.

Archcare Community Life Member handbook  here. 855-467-9351
Centers Plan for Healthy Living

Grievance & Appeals Appeal info here  

Where to request appeals here.

Member handbook here (4 languages) (3/2017)


 Centers Plan for Healthy Living Advantage Care HMO
75 Vanderbilt Avenue
Staten Island, NY 10304
Attention: Grievance and Appeals Department

TEL:  855-270-1600 ext 3792

FAX:  347-505-7089

E-mail: GandA@centersplan.com

ElderServe Health Inc. Corporate Policy - MLTC - Appeals from Adverse Determinations, undated. Corporate Policy - MLTC - Grievance Procedure, undated. 800-370-3600
Fidelis Care at Home

Corporate Policy - MLTC - Appeals from Adverse Determinations, last revised August 22, 2011.  Appeals information begins on p. 8.

Corporate Policy - MLTC - Greivance Procedure, p. 1

Member handbook   here.

Guildnet MLTC

Corporate Policy - MLTC - Appeals from Adverse Determinations, dated Dec. 21, 2005.

Corporate Policy - MLTC - Grievance Procedure, dated July 2005.

Corporate Policy - MLTC - Appeals of Grievances, dated July 2005.

HealthPlus MLTC (Empire BlueCross Blue Shield)

Corporate Policy - MLTC  - Appeals of Adverse Determinations, last revised March 24 , 2011 

Corporate Policy - MLTC - Grievance Procedure, last revised Dec. 28, 2011.

HomeFirst, Inc. MLTC (ElderPlan)  


Independence Care System

Member handbook available in English and Spanish. (2012)

 877-427-2525 or   877-ICS-2555         Fax 212-584-2555.

Integra MLTC
MetroPlus Appeals and Grievance info starts on page 19 of the member handbook - English and Spanish (2014)


Fax 212-908-5282

Montefiore Diamond Care (Bronx)
RiverSpring at Home
Senior Health Partners (Healthfirst ) 866-585-9280
Senior Whole Health of New York - MLTC

Member handbook available here.


UnitedHealthcare Personal Assist

Member handbook  beginning page 30. Spanish. (2014)


VillageCare Max Member handbook  beginning page 29.



Member handbook  beginning page 58.


WellCare Advocate MLTC Appeals information available here.  Member handbook    here. 877-395-4282

2. Medicaid Advantage Plus (MAP) Information on Appeals or Grievances

Plan Name Appeals Information Grievance Information  Phone Number  Member Handbook and Additional Notes
Elderplan, Inc. Draft Corporate Policy MAP Appeals from Adverse Determinations, no date. Draft Corporate Policy MAP Grievance Procedure, no date. 866-386-9437 Elderplan materials available here.
Emblem Health (formerly Health Insurance Plan HIP) Online appeal information here. 888-447-9161
Fidelis Draft Corporate Policy MAP Appeals from Adverse Determinations, dated August 2009.  For Appeals see p. 9. Draft Corporate Policy MAP Grievance Procedure, dated August 2009.  For Grievance see p. 1. 877-533-2404
Guildnet Gold, Inc. 800-932-4703 or 800-815-0000 Member handbook available here.
HealthFirst Complete Care

Corporate Policy MAP Notice of Action and Appeals, no date.

Corporate Policy MAP Appeals from Adverse Determination, last revised Sept. 2011.

Corporate Policy MAP Grievance Procedure, no date.  Note track changes in document. 888-260-1010
HealthPlus, an Amerigroup Company Corporate Policy MAP Appeals from Adverse Determinations, effective date Feb. 1, 2010. Corporate Policy MAP Grievance Procedure, no date.  Note track changes. 866-805-4589 Member handbook available here.
Senior Whole Health M/M Plus 877-353-0185 Member handbook available here.
VNSNY CHOICE Total 866-597-6674 Member handbook available for download here.
WellCare Advocate Complete 866-661-1232 Evidence of Coverage  available  here.

3. Program for All Inclusive Care for the Elderly (PACE) Information on Appeals or Grievances

Plan Name Appeals Information Grievance Information  Phone Number  Member Handbook and Additional Notes
ArchCare Senior Life 866-263-9083
Centerlight Healthcare PACE 877-226-8500 Member rights listed here.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.


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