STATE OF NORTH CAROLINA
OFFICE OF ADMINISTRATIVE HEARINGS

INFORMATION ABOUT THE MEDIATION PROCESS

MEDICAID APPEALS

Mediation Process 
Mediation is the first step in the appeal process for your Medicaid benefits. It is the process where a Medicaid recipient and a representative for DHHS, the respondent, use the assistance of a neutral third party to explore options for a mutually acceptable resolution.  The focus is on reaching agreement based on each party’s interest rather than making a decision as to who is right or wrong. The expectation is that the parties will enter into mediation in good faith with the goal of reaching an agreement. If, however, an agreement cannot be reached to the satisfaction of both parties, the petitioner has the right to proceed to a formal hearing before an Administrative Law Judge with the Office of Administrative Hearings. Although mediation is highly recommended, mediation may be declined by the recipient.
Mediator’s Role
A mediator serves as the neutral third party whose role is to guide the mediation process, facilitate communication, and to help the parties generate and evaluate possible outcomes. A mediator does not act as a judge, give advice, express an opinion on who is right or wrong, and does not render decisions. At times the mediator may meet separately with the participants during the mediation to further the communication process. 
Participant’s Role 
You and the agency should come to mediation prepared to tell your version of what happened, prepared to listen to the views of the other side, prepared to clearly state your requirements for resolving the grievance, and to be willing to negotiate a settlement agreement that will be mutually satisfying for both sides if possible. 
Who Attends 
Mediation is a formal part of the appeal process; therefore, only the recipient and the respondent can attend the mediation. Representatives and advisors may be permitted to attend as required to mediate the dispute. 
Time Expectations 
Sessions typically last approximately an hour; however, there is no time limit on the length of the mediation process. The time spent in the mediation is governed by the complexity of the issues and the participants’ commitment to reach a mutually satisfactory resolution. If the parties are close to reaching agreement, mediation may be reconvened for another date for the additional time needed so long as it remains within the statutory time-lines. 
Consultation During the Mediation Process
You and the agency will have the option to request a recess at any time during the mediation to obtain legal advise or consult with anyone you feel would be helpful as alternatives for resolution are discussed and to review the mediation agreement. It is vital that both you and the agency make prior arrangements with those individuals to be available for consultation during the scheduled mediation. Both parties may have their legal counsel or other advisors review the mediation agreement during the mediation if desired. Due to time constraints, recesses of no more than 15 minutes are recommended. 
Confidentiality 
The mediation process is considered confidential with only information shared that is needed to effectuate reaching and processing a mediation agreement. Both parties are asked to respect the confidentiality of the process by not disclosing information that is discussed in the course of the mediation session. Exceptions to confidentiality as set forth in the Supreme Court rules are: reports of abuse, threats of physical harm to self or others, and threats to cause significant damage to real or personal property.