How to Appeal - County of Financial Responsibility Determination for Behavioral Health Fund

Appeal Rights

You have the right to appeal this decision (County of Financial Responsibility determination for Behavioral Health Fund county cost share). You can complete the request for appeal by filling out this form: Request for Department Resolution of Financial Responsibility Dispute (DHS-4457).  Follow the directions on the form for submission instructions:

Request for Department Resolution of Financial Responsibility Dispute (DHS-4457)

Appeals Office
Minnesota Department of Human Services
PO Box 64941
St. Paul, MN 55164-0941
Phone: 651-431-3600 | Fax: 651-431-7523

The request for a hearing must be received within 30 days after getting written notice of the agency's decision. If you show good cause for not appealing within this time limit, you may appeal up to 90 days. For more information about appeals, visit the Appeals Frequently Asked Questions.

Appeals Frequently Asked Questions