This form is only applicable if you are a Medicaid recipient/applicant who wants to request an appeal of a decision made on a Medicaid case or application.
This form is only applicable if you are a Medicaid provider (not Medicaid recipients/applicants) who wants to request an appeal. You must upload a copy of the decision letter from which you are appealing with your request.
Complete this form if you want to appeal a finding by DCFS regarding a child abuse and/or neglect investigation. You must upload a copy of the notice letter received from DCFS informing you of the finding and your appeal rights. If you do not attach the notice letter, your appeal will be rejected as incomplete.
