The appeal request should include your personal contact information:
- name
- phone number
- email
- home address
Note: If you are filling this out for the Assisted Living resident, include the resident’s contact information as well.
The appeal request must include the reason for your appeal. Reasons you can appeal are:
- If you disagree that the Assisted Living place can end your contract.
- If ending your Assisted Living contract would cause you a lot of harm.
- If you fixed the reason why the Assisted Living place wanted to end your contract. OR if you have another way to resolve the issue. This might be something like a reasonable accommodation, modification, intervention, or alternative to ending your contract.
- If the Assisted Living place ended your contract in a way that violates state or federal law.
It is VERY helpful to MDH if you also include the notice you got from your Assisted Living place that says your contract is ending or won’t be renewed.