MFTD Waiver Families

Support for families of children in the Medically Fragile, Technology Dependent Waiver

Appeals Overview

Many waiver families have had to appeal because Illinois Department of Healthcare and Family Services routinely cuts hours or does not grant the number of medically necessary hours a child's doctor recommends. While appealing may seem a tedious process, many families have successfully won their appeals. You may appeal your child's number of approved hours and your child's number of approved respite hours. Your nursing agency may also appeal your child's reimbursement rate.

Official information on Appeals from DSCC can be found here. Note that because DSCC is paid to operate the waiver for HFS, they are unable to assist with appeals.  

To appeal, submit a letter of intent to appeal, including your child's name, Medicaid case number and ID number, program, and what you are appealing. Also request a copy of all relevant documents used to determine your child's needs. In order to maintain your current hours, this letter must be submitted within 10 days. Send this letter by certified mail or another service that will prove when it was sent and that it was received. A sample letter is available below. The address is:

Illinois Department of Human Services
Fair Hearing Section
69 W. Washington, 4th Floor
Chicago, Illinois 60602

Other ways of submitting your letter:

  • Email the completed letter or appeal form to:
  • Fax the completed letter or appeal form to (312) 793-2005
  • Call toll free 1-800-435-0774 (voice),  (855) 418-4421, or 1-877-734-7429 (TTY), Monday through Friday, between 8:30 am and 4:45 pm.
  • Take your letter or appeal form to the local IDHS office. If you need help filling it out, your local office staff will help you.

Some families may be able to appeal online through, but some children in the MFTD are unable to access this system. If you have an ABE account, login. If you do NOT have an ABE account, create one and follow the prompts to link your ABE account to your IES Case information and then file the appeal. If you have a Manage My Case Account, log into that account and click on File and Appeal.

Shortly thereafter, you should receive a confirmation letter followed by a date for your hearing a few weeks/months after that. You may request an expedited hearing or phone hearing if you think one is necessary.

Families who have been through an appeal will be more than willing to help you. Please contact us at for more information and access to other families who have navigated through this process. 

We have several additional pages on appeals.  Most require a password for access. Please contact us in order to obtain the password. The Appeals Steps page gives a general overview of the steps required in an appeal. For more information on creating the contents of your appeal argument, including issues with the point scales, level of care tools, or the evaluation, see the Appeals Toolkit. A Sample Appeals Letter is also available. Legal citations and links relating to appeals can be found on the Appeals Legal Information page.

Sample Letter of Intent to Appeal

Illinois Department of Human Services
Fair Hearing Section
69 W. Washington, 4th Floor
Chicago, Illinois 60602

To Whom it May Concern:

This letter represents an official appeal of the decision regarding home nursing care for my child [child's name], dated [date of letter]. The Case ID number is [Case ID] and the recipient number is [recipient number].

[Child's] physician, [doctor name], requested [number of hours] hours of nursing care per week, with substantial justification of medical necessity. [Child] was only awarded [awarded number of hours] hours per week, which is insufficient to meet [his/her/their] medical needs, including [list of medical needs].

We kindly request a copy of the file, including any other pertinent records, within 14 business days. Please include my child's Level of Care Tool evaluation, as well as any other evaluations. These may be sent electronically to [email address] or mailed to our home address at [address].


[Your Name]

Include a copy of your letter and mail using certified mail or an equivalent service that proves receipt of the letter

Reasons to Appeal

The following are the most common reasons for an appeal, and when the appeal should be made.

  1. Your child's hours award or budget has been reduced or eliminated even though there was no change in medical status. You should appeal within 10 days of receipt of your award letter. Keep both the letter and the envelope it came in to prove that date. If you appeal within the 10-day window, your child will be allowed to keep his/her current number of hours or budget during the waiting period before the appeal is heard. You may also appeal after the 10-day window, but your child's hours/budget may be reduced while you wait for the appeal. 
  2. Your child did not receive the number of hours (or equivalent budget) that his/her/their physician requested. You should appeal within 60 days of receiving your award letter. If your child's medical needs would be impacted by not having enough hours during the waiting period, you may request an expedited hearing.
  3. Your child has had a change in medical status requiring more hours. You may apply for a temporary or permanent increase in hours due to a medical status change at any time. First contact your DSCC coordinator, as many of these appeals can be done informally and quickly without an appeal hearing. You will need a physician's letter explaining the need for an increase in hours. 
  4. Your child requires more hours due to a change in the family situation. You may apply for a temporary or permanent increase in hours due to a family situation change at any time. Changes in the family situation include a change in school attendance, a caregiver working more hours, a caregiver unable to provide some/all care, or changes due to a death in the family or divorce. First contact your DSCC coordinator, as many of these appeals can be done informally and quickly without an appeal hearing. Note that under EPSDT, hours awards are based on medical necessity and not caregiver availability, and most children in this program require 24/7 nursing care. Caregivers cannot be forced to provide more hours of care than they are capable of providing. 

More Appeals Info

Click below to go on for more information:

Appeals Steps

Appeals Toolkit

Appeals Sample Letter