Appeal and Informal Review Process

The goal of NY State of Health, also called the Marketplace, is to help you and your family get health insurance you can afford. One way we do this is by giving you a chance to buy qualified health plans. Sometimes you can even get help paying for this coverage.

Another part of our job is deciding if you meet the requirements for enrolling in the Essential Plan, Medicaid or Child Health Plus. These programs allow you to get health care for you or your children at no-to-low cost.

To do our job, the Marketplace must make many decisions about how your situation fits the rules for these health care programs. Sometimes, you will not agree with the eligibility determinations we make. When this happens, you can ask us to reconsider and change our determination. A request to change our determination can be made by contacting the Marketplace through the informal review process and by requesting an appeal.

Click on the topics below to learn more about:

• Informal Review Process and Hearings
• Issues that can be appealed through NY State of Health’s Appeals Unit
• Request an Appeal – You can make a request for an Appeal by telephone, U.S. Mail, or fax.
• Request an Adjournment or Reopening - If you cannot appear at your scheduled hearing, you may request that it be adjourned (postponed) to another date. You may submit your request for an adjournment only by telephone. If the hearing date has already passed and you did not attend the hearing, or if you need another adjournment, under some limited circumstances you may be able to have the hearing rescheduled.
• Cancel an Appeal – If you no longer need the appeal that you requested, let us know by telephone, U.S. Mail, or fax so that it can be canceled.
• Search the Appeal Decision Archive – The Appeals Unit of NY State of Health publishes its Appeals Decisions on the Internet. We have removed all personal and confidential information. If you want to look at past decisions or find other ones with facts similar to your situation, you may search this archive.

Contact NY State of Health

To start the Informal Review Process, file an appeal, or if you have questions about the appeals process, contact NY State of Health by:

Mail: NY State of Health
Appeals Unit
P.O. Box 11729
Albany, NY 12211

The purpose of this site is to provide information about the Informal Review and Appeals Processes for NY State of Health and to make available Appeals Decisions rendered by the NY State of Health Appeals Unit. As decisions are redacted, they will be added to this database. Any personally identifiable information has been removed from these decisions. Links to forms will be added as the forms become available and related materials will be added over time. Please use the Contact Us link on this page with any questions or comments.