NC Medicaid DSS-1473 State Appeal Request Form: Filing and Hearing

If a North Carolina County Department of Social Services has denied, reduced, or terminated your Medicaid benefits, you can challenge that decision through a state-level fair hearing, and the paperwork is handled on the NC Medicaid DSS-1473 state appeal request form. You do not download and mail this form yourself. You go to your County DSS office, tell the caseworker you want to appeal, and the county completes the DSS-1473 and submits it electronically to the DHHS Hearings and Appeals Section in Raleigh within five days of your request.¹ A neutral hearing officer then takes the case independently of the local office that made the decision.

Which Decisions the DSS-1473 Covers

The form is for disputes about County DSS eligibility and benefit decisions in fee-for-service Medicaid. The appealable issues listed on the form are:¹

Application denied
Benefits or services terminated
Benefits or services reduced, modified, or changed
Overissuance charged (the county says you were overpaid and wants repayment)
Administrative disqualification

One important boundary: if you are enrolled in a Medicaid managed care plan (sometimes called a Prepaid Health Plan) and your dispute is with the plan rather than the county, the plan has its own internal appeal that you must exhaust first, and the state fair hearing on that track runs through the Office of Administrative Hearings with a 120-day filing window, not the DSS-1473.²

Before any adverse action takes effect, state law requires the Department to send you written notice at least 10 days ahead, with instructions on how to appeal.³ Hold onto that notice. A copy of it has to be attached to your DSS-1473.

How to Start the Appeal at County DSS

Go in person to the County DSS office that handled your case and tell them you want to appeal. The caseworker fills out the DSS-1473 using what you provide, then sends it by secure email (ZixMail) to Medicaid.DSS.State.Appeals@dhhs.nc.gov.¹

Bring with you:

The notice of action or decision from the county. A copy goes on the form.
Your Medicaid identification number, which appears on your Medicaid card and on the notice.
Your full legal name, current mailing address, and phone number as you want them listed for hearing correspondence.
A plain statement of why you think the decision is wrong. Legal arguments are not required at this stage.

You can represent yourself, or you can appoint someone else. The statute allows legal counsel, a relative, or any other spokesperson to act for you.³ If you name a representative, give the county their name, address, and phone number so hearing notices reach them too.

Choosing Your Hearing Format

You pick the format at the time you file. The DSS-1473 offers three options:¹

In-person at your County DSS office with all parties present.
Remote phone hearing conducted entirely by telephone.
Remote video hearing through Microsoft Teams. You must provide an email address so the link can reach you.

If your case rests on documents you want to walk a hearing officer through, like medical records or financial statements, in-person or video usually works better. Phone hearings are fine when the dispute is a straightforward eligibility calculation.

Keeping Benefits Running While You Appeal

If the county is cutting off or reducing benefits you already have, you may be able to keep them in place during the appeal. Under North Carolina administrative rules, a termination or reduction does not take effect until 10 business days after the notice is mailed.⁴ File your appeal inside that window and ask the county about continuing benefits (often called “aid paid pending”) until the hearing officer rules.

There is a trade-off. If you keep benefits during the appeal and the hearing officer sides with the county, Medicaid may try to recover the cost of services paid out while the appeal was pending. Think about the dollar amounts before you ask for aid paid pending.

What Happens After the County Submits the Form

Once DHHS receives the DSS-1473, it assigns a docket number and mails you a notice with the date, time, and format of your hearing. Use the gap between filing and the hearing to pull together whatever you plan to show the hearing officer. The officer has not read your file in advance, so anything you want considered has to be brought to the hearing.

The Hearing

The hearing is not a courtroom trial. It runs more like a structured conversation. You or your representative explain why the decision is wrong. A representative of the County DSS explains why the decision was made. The hearing officer asks questions and looks at the evidence from both sides.

Tentative Decision, Then Final

The hearing officer first issues a tentative decision by mail. If it goes against the county, the county gets it by certified mail; if it goes against you, you get it by certified mail.⁵

Either side then has 10 calendar days from the date on the tentative decision to submit written arguments or ask for oral argument before the Chief Hearing Officer. If no one responds in those 10 days, the tentative decision becomes final. If arguments come in, the Chief Hearing Officer weighs them and issues the final decision by certified mail.⁵

When the final decision favors you, the County DSS must put it into effect within two weeks of receiving it, whether that means reinstating benefits, reversing a denial, or correcting whatever action triggered the appeal.⁵

If You Lose the Final Decision

The final decision has to include information about your right to seek judicial review.⁵ For Medicaid contested cases, judicial review is filed as a Petition for Judicial Review in the Superior Court of the county where you live, within 30 days of being served with the final decision.⁶

Judicial review is more formal than the administrative hearing. The Superior Court judge generally looks only at the evidence that was in the administrative record. New documents and new testimony usually cannot be introduced at this stage. If the filing fee is a problem, ask the court clerk about a fee waiver. Talking to an attorney before you file is worth the time.

Interpreters and Disability Accommodations

Ask for accommodations as early as you can, ideally during your first visit to the County DSS. For spoken-language interpretation, call the Hearings and Appeals Section directly at 919-814-0090 so an interpreter can be arranged for your hearing date. The Division of Services for the Deaf and Hard of Hearing runs a Medicaid Communication Access Service for sign language and related support,⁷ reachable at 919-527-6930 (voice), 919-715-0933 (TTY), or 919-890-0859 (videophone).

Hearings and Appeals Section Contact Information

The County DSS submits the form, but you may need to reach the state office about scheduling or hearing status.⁸¹

Phone: 919-814-0090
Fax: 919-882-1179
Email: Medicaid.Hearings@dhhs.nc.gov
Mail: North Carolina Department of Health and Human Services, Hearings and Appeals Section, 2418 Mail Service Center, Raleigh, NC 27699-2418

1
North Carolina Department of Health and Human Services. NC Medicaid DSS-1473 State Appeal Request Form
2
NC Office of Administrative Hearings. Filing a Contested Medicaid Recipient Appeal
3
North Carolina General Assembly. North Carolina Code 108A-70.9A – Definitions; Medicaid Recipient Appeals
4
North Carolina Office of Administrative Hearings. 10A NCAC 21A – Medical Assistance Administration – Section: 10A NCAC 21A .0301 Notice
5
North Carolina Office of Administrative Hearings. 10A NCAC 21A – Medical Assistance Administration – Section: 10A NCAC 21A .0303 Appeal Decision
6
NC Office of Administrative Hearings. Appeal a Medicaid Recipient Appeal Decision
7
North Carolina Department of Health and Human Services. Division of Services for the Deaf and Hard of Hearing
8
NC Medicaid. Appeals