CFSS/PCA Appeals

If your assessment for services says you don’t need a personal care assistant (PCA), or if a yearly assessment reduces the hours of the care you have been getting, and you don’t agree, you can appeal. Your notice should have instructions about how to do this.

How you start the appeal depends on if you have a managed health care plan or not. Managed health care health plans are run by insurance providers like Medica and others.

Call the health plan directly, or fax or mail them a letter. The phone number, fax number and address for submitting the appeal should be on the notice from the health plan. Their phone number should also be on your health insurance card and other health plan materials. Tell them that you want to appeal.

• You have to appeal within 60 days of the date on the assessment notice. 
   
• If you want to keep your CFSS/PCA hours during your appeal to the health plan, you have to say that in your appeal. And you have to appeal:
  • within 10 days after the health plan sent the notice or
  • before the date your CFSS/PCA hours are going to stop or be reduced (whichever is later). 
     

If you win the appeal and the health plan changes its decision, you shouldn’t need to do anything else. It is a good idea to let your CFSS/PCA agency know that you won and be sure that they are told that by the health plan. 

If you don’t win, the next step is to appeal to the state. See “How do I appeal to the state” below.

• You have to appeal to the state within 120 days from the date on the health plan’s decision letter. 
   
• If you want to keep your PCA hours during your appeal to the state, you have to say that when you appeal and appeal within 10 days after the health plan sent their decision letter. If you don’t appeal within 10 days, you won’t get to keep the hours you had before they were reduced.

Appeal directly to the state to get a DHS Appeal Hearing with a Human Services Judge. You must appeal in writing or on their website. See the section “How do I appeal to the state?”

• You have to appeal within 30 days of the date of the notice. But you can appeal as late as 90 days if you have “good cause” (a good reason) to appeal late. After 90 days it is too late to file an appeal. 
   
• If you want to keep your CFSS/PCA hours during your appeal, you have to say that when you appeal. And you have to appeal:
  • within 10 days after the health plan sent the notice or
  • before the date your CFSS/PCA hours are going to stop or be reduced (whichever is later). 

You have to fill out a form or write a letter to appeal. A phone call is not enough to start an appeal to the state. There are different ways you can get your appeal to the state. 

Online
You can fill out a form and submit your appeal online on the Department of Human Services (DHS) website. 

By mail or fax
You can print the blank form from the DHS website or get the form from the county. If you don’t want to use a form, it is okay to just write a letter and mail or fax it to the state. 

Make sure you put these things in your letter:

• Say you want to appeal the reduction in your CFSS/PCA hours and why.
   
• Ask to keep getting your benefits during the appeal process.
   
• If you want an in-person hearing, write that in the appeal. If you don’t ask for an in-person hearing, you get a hearing done by phone.
   
• If you need an interpreter, ask for one and say what language.
   

Make sure you put your case number and the date on your letter. Keep a copy for yourself. Give the letter to your county worker and mail or fax it to:

Minnesota Department of Human Services Appeals Office
PO Box 64941
St. Paul, MN 55164-0941 

Phone: 651-431-3600    
Fax: 651-431-7523

Keep confirmation that you sent it. A receipt or fax report works. 

You get a notice of the hearing date from a Human Services Judge. If you need more time to get ready, or can’t go on the date they give you, ask the judge for a “continuance.” A continuance means that the judge sets a later date for the hearing. The phone number to call DHS to ask for a continuance is on the hearing notice. 

Get copies of your recent medical records from your doctor and any hospitals, emergency rooms or clinics you went to recently. The county or your managed care health plan should pay for the records. You can also ask your doctor to write a letter about how your condition limits you and why you need CFSS/PCA help. If you are appealing because your CFSS/PCA hours were reduced, get copies of your PCA assessments you had before.  If you have a health plan, ask the health plan for the old assessments. You can also ask your CFSS/PCA agency or the county for them.

You can have witnesses at the hearing. You, your personal care assistant, and others who know about your condition and why you need PCA help can testify at the hearing. The judge needs to know your witnesses’ names and phone numbers before your hearing.

Mail or fax copies of the documents and witness information to the judge before the hearing. You should also send copies of all these things to your health plan or the county. If your hearing is in person, you can bring your papers to the hearing. 

After the hearing, you get a written decision from the judge. If the judge rules against you, you can ask DHS for “reconsideration,” or you can appeal the judge’s decision to the State District Court in the county where you live. The written decision from the judge has instructions on how to appeal, and you can also read our fact sheet Public Benefits Appeals to District Court. 

For a more complete description of DHS appeal hearings, see the Appeals Frequently Asked Questions (FAQs) on the DHS website. 

If you want to learn more about PCA appeals or ask for help with your appeal, call your local legal aid office at 1(877) 696-6529as soon as you can for help or referrals.

You can also look for other programs at https://www.lawhelpmn.org/providers-and-clinics.