MedicaidAdministrativeLow impact
5160-80-09 - Administrative appeal of the hearing decision. (New/Final File)
Ohio Medicaid·OH·Program Integrity
Effective date
Jun 13, 2016
We identified it
Jun 20, 2026
Summary
Ohio Medicaid has finalized Rule 5160-80-09 establishing procedures for administrative appeals of hearing decisions. This creates a new appeals process for providers who disagree with Medicaid hearing outcomes related to claims, audits, or other program integrity matters.
Action Required
Review the administrative appeal process for Ohio Medicaid hearing decisions. Update office procedures to include information about this appeals option for any future Medicaid audit or claim disputes that result in unfavorable hearing decisions. Designate staff member to handle potential appeals if needed.