FY24 Grievances and Appeals

Grievance and Appeals Overview

We gather and review Medicaid and Healthy Michigan Plan grievance and appeal information every few months. Below are highlights from this past fiscal year, October 2023-September 2024. This data includes all 8 Community Mental Health (CMH) agencies and cases filed with Southwest Michigan Behavioral Health (SWMBH) directly.

The number of grievances has lowered in the past two years. But we are seeing more complex concerns. We need to take more steps to look into and resolve the issues. Of the 154 complaints filed in FY24, 104 were about interactions with staff. The other two main types of complaints were access and quality of care (clinical concerns).

In our region, the number of appeals filed continues to grow from year to year. This could be due to several factors. Our counties are doing careful reviews of service amounts and levels of care needed. We have had some customers lose Medicaid or waiver status. We have had more providers file appeals. We have sent more notices when customers do not go to their services.

We had 6 cases go to a State Fair Hearing with an Administrative Law Judge. Of these cases, we had 4 dismissed during the hearing process, and 2 decisions that were supported by the Judge.

If you have questions or would like to learn more about grievances or appeals, please call Customer Service at 1-800-890-3712 or email us at: customerservice@swmbh.org.