How to file a complaint, including about us
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A Medicaid waiver member can complain about any provider involved in their care, including their own case management agency. Routes run in parallel: the agency's internal process, the Area Agency on Aging, and the state. Complaining does not put services or eligibility at risk, and it costs nothing.
You can complain about us
Start there, because it is the part most agencies leave off their websites.
If Apple Community Health Services does something wrong – a call not returned, a request ignored, a right not honored, a case manager a family cannot work with, a plan that does not reflect what was said – there is a route for saying so, and using it is not a problem. It is how an agency finds out what it is getting wrong.
There is also an external route that does not run through this agency at all, for anyone who would rather not raise it with us directly. Both are set out below.
What a complaint is for
A complaint, or grievance, is about conduct or quality: how someone was treated, what was not done, what was promised and did not happen.
That is different from an appeal, which challenges a formal decision – a service denied, reduced or stopped, or eligibility ended. Appeals run to a short deadline printed on a written notice, and they go down a different track. See appeals and fair hearings.
If both apply, use both. Nothing about one route closes the other.
Abuse, neglect or exploitation is not a grievance and should not wait for one. See how to report abuse, neglect or exploitation.
The routes
They run in parallel. A member does not have to work through them in order, and does not have to give one route a chance before using another.
1. The provider agency. For a problem with the people delivering a service – missed visits, short visits, a worker who is not a fit. This is usually the fastest fix, because they are the only ones who can change tomorrow’s schedule. See what to do if a service isn’t showing up.
2. The case management agency. For a problem with coordination, with the plan of care, with communication, or with the agency itself. Every case management agency has an internal complaint process. Ask for it by name, ask who handles it, and ask what the timescale is for a response.
3. The Area Agency on Aging. The regional body that serves as the front door to the aging services network can take complaints about services in its region and can direct a member to the right place when it is not clear who is responsible.
4. The state. Georgia’s Department of Community Health oversees the waiver and the agencies delivering it. Complaints about a Medicaid provider’s conduct or compliance can go to the state directly, without going through the provider first.
How to make a complaint that gets somewhere
Complaints succeed on specifics.
- Dates. What happened and when. “Three missed visits: 4, 11 and 18 August.”
- Names. Who you spoke to, on what date, and what they said.
- What you asked for. The request that was not met, and when you made it.
- What you want to happen. A fixed schedule, a different worker, a plan corrected, an explanation, an apology. Saying what would resolve it makes resolution possible.
- In writing where you can. A phone call is a fine start. An email or a letter creates a record on both sides.
Keep a copy of everything you send, and note the date you sent it.
What should happen next
A complaint should be acknowledged, looked into by someone who was not the subject of it, and answered. Ask at the outset what the timescale is, and follow up in writing if it passes.
If the answer is unsatisfactory, the external routes remain open. And separately from any complaint, a member always retains the right to change provider – including changing case management agency – with or without a reason.
No retaliation
A member’s services, plan of care and eligibility do not depend on their willingness to be easy to deal with. Nobody’s care may be reduced, delayed or withdrawn because they complained, and any suggestion otherwise is itself a serious matter to report to the state.
Questions people ask about this
Can I complain about my own case management agency?
Yes. A member may complain about any organization involved in their care, including the agency coordinating it. Every case management agency is required to have a complaint process, and there are external routes that do not go through the agency at all.
Will complaining affect the member's services or eligibility?
No. Filing a grievance is a normal part of a Medicaid program. It does not affect eligibility, does not affect the plan of care, and is not grounds for any agency to treat a member differently. Retaliation would itself be a serious matter to report.
What is the difference between a complaint and an appeal?
A complaint is about conduct or service quality - a worker who did not show up, rudeness, a request ignored, a right not honored. An appeal challenges a formal decision about services or eligibility, such as a denial or a reduction, and runs to a deadline stated on a written notice.
Do I have to complain to the agency first?
No. The routes run in parallel, not in sequence. Going to the agency first is often faster because they can fix the problem directly, but a member who does not want to, or who has tried, can go to an external route straight away.
Can a complaint be made anonymously?
Some routes accept anonymous reports, though an anonymous complaint is harder to investigate because nobody can be asked follow-up questions. A member worried about consequences should say so when filing - concern about retaliation is itself relevant information.
Related questions
- When a service is missed A step-by-step escalation route when a waiver service is missed, late or short: the provider first, then the case manager, then a formal complaint.
- Appeals and fair hearings How Medicaid appeals work when a Georgia waiver service is denied, reduced or stopped: the written notice, the appeal, and the right to a fair hearing before a hearing officer.
- Reporting abuse or neglect Where to report suspected abuse, neglect or financial exploitation of an older or disabled adult in Georgia, and which route to use depending on where the person lives.
- Changing a provider How an enrolled EDWP member changes a service provider or their case management agency in Georgia, what the case manager must tell them, and what happens to the care plan.