Medicaid managed care contracts differ from commercial contracts, both in the federal and state legal requirements to which they are subject and in the populations contractors serve. They also differ in their grievance procedures. Under federal law, Medicaid managed care contracts are required to have state-approved internal grievance processes. Also, Medicaid beneficiaries have certain due process protections that commercial plan enrollees do not, in particular, the right to contest decisions through state fair hearings. These protections are designed to serve Medicaid beneficiaries, many of whom – because of low literacy and reading comprehension levels – may lack the skills necessary to advocate for themselves in a managed health care delivery system and may need assistance in developing and submitting grievances. Ten states that have incorporated numerous grievance procedures into their Medicaid managed care programs were included in this report.