Step 2

If a meeting with your SSC does not change the eligibility status, and your child is still denied eligibility, within 45 days of the date of the notice families can appeal to the State of Wisconsin’s Division of Hearings and Appeals (DHA). To start this process, visit Request a Hearing for specific instructions.

Note: Families absolutely must be sure to sign and date their request. Many requests are returned to families for missing signatures.

You can also send a letter or write on a copy of the Notice of Action of Denial that you would like to appeal through a fair hearing process, with your signature and date, and mail this request with your name, address and phone number to Division of Hearings and Appeals, PO Box 7875, 53707-7875.

To prepare for an appeal to eligibility for the CLTS Program consider collecting the following

• • • Collect medical records to provide more details about your child’s condition. You can reference these details (diagnoses, test results, etc.) when speaking with the Administrative Law Judge.
    • Request letters from your child’s doctors, therapists or community providers and offer to send copies to the judge.

Organizations to Assist Families with Appeals

• • • Disability Rights Wisconsin, disabilityrightswi.org or (800) 928-8778.
    • ABC for Health, safetyweb.org or (800) 585-4222

Denial of a requested item or service

There may be times when an item or service is not approved. There are also times when the quantity of an item requested is reduced. It may take time and effort to appeal, however, it’s important to know that Wisconsin’s CLTS Program has a process to reconsider these denials. Knowing your rights and the steps to take will go a long way toward resolving the issue.

Know Your Rights 

When an item or service is denied, but within the scope of the CLTS program, a notification called a Notice of Adverse Action, is sent to the family. It includes important next steps families can take if they choose, including: 

• The action that will be taken and why.
• When the action will be taken.
• Your rights, including your right to appeal.
• Timeline to appeal the decision

Steps to Appeal a Denial for a Service or Item

Step 1: Request a meeting with your child’s SSC to review what was denied. We recommend families be open to creative and flexible solutions to the issue the item is intended to help or support. Learning and understanding the reason for the denial or reduction in coverage is helpful to understanding the options that may be covered, and it can offer insights into the possibility of filing an appeal.

Step 2: Review the outcomes that were written into your child’s ISP to ensure the requested item or service supports a goal or outcome that was identified in that plan. Remember, all requested items or services must be supported by the goals and outcomes in the ISP.

Step 3A: If you firmly believe the requested service or item is the best way to meet the stated outcomes, you must begin the appeal process within 45 days of notification of the denial. The appeal process does not require an attorney.

Step 3B: If you are not seeking a change in decision, but would like the county to acknowledge your complaint, filing a grievance with the county could be your next step. A grievance does not seek to change outcome of the decision but is a way for the agency to acknowledge your concerns. Each county’s grievance process is different but can usually be found on the county government website.