× In response to Hurricane Ida, certain legal deadlines are suspended statewide through September 24, 2021. DAL cannot provide legal advice on how this may impact your case. For more information, see Executive Proclamation Number 170 JBE 2021 and the August 31, 2021 Order issued by the Louisiana Supreme Court.

Medicaid Recipient/Applicant Appeal Request

This form is only applicable if you are a Medicaid recipient/applicant who wants to request an appeal of a decision made on a Medicaid case or application.

 

Medicaid Provider Appeal Request

This form is only applicable if you are a Medicaid provider (not Medicaid recipients/applicants) who wants to request an appeal. You must upload a copy of the decision letter from which you are appealing with your request.

 

DCFS - Appeal Request for Investigation Finding

Complete this form if you want to appeal a finding by DCFS regarding a child abuse and/or neglect investigation. You must upload a copy of the notice letter received from DCFS informing you of the finding and your appeal rights. If you do not attach the notice letter, your appeal will be rejected as incomplete.