How To File An Appeal

You have the right to appeal decisions made by HealthSourceRI and the Department of Human Services and to request a fair hearing. A fair hearing is a chance for you to tell an administrative officer why you disagree with the agency's decision. An agency representative is also present at the hearing to explain the basis for the agency decision.

You may file an appeal (or an expedited appeal) and also request Aid Pending by logging into your Account at www.healthyrhode.ri.gov. If you need assistance filing an appeal, please call HealthSource RI at (855) 840-4774. You may also fax your request to (401) 223-6317.

How to Request an Appeal - Instructions and Form

Appeal Instructions and Form - English.pdf PDF file, less than 1

Appeal Instructions and Form - Spanish.pdf PDF file, less than 1

Appeal Instructions and Form - Portuguese.pdf PDF file, less than 1