Medicaid Fair Hearing Request

A hearing request must be filed within 90 days after the order or action complained of, or up to 180 days for good cause (a substantial and compelling reason beyond the party's control, not mere inability to understand…

The department must set the hearing to begin within 30 working days after the request and give at least 10 days' written notice, and records the agency must let the claimant examine must be available at least five…

Within one year after notice of the department's final decision, the applicant, recipient or county may petition the superior court under Code of Civil Procedure section 1094.5 for review on questions of law, with no…

An applicant or recipient dissatisfied with a county action on an application or receipt of public social services, including Medi-Cal, or with delay in acting on an application, may request a state hearing from the…

The hearing is conducted impartially and informally, testimony is under oath or affirmation, the hearing officer is not bound by judicial rules of procedure or evidence, and the claimant may appear with or without…

CDSS hearing regulations that 22 CCR section 50953 applies to Medi-Cal hearings, including section 22-004 (a request may be written or oral), section 22-009 (90 days after the action or notice, up to 180 days for good…

Connecticut notice procedure before a transfer penalty: the Commissioner sends a preliminary notice stating that the applicant may contest the penalty by filing an undue hardship claim or by rebutting the presumption in…

Connecticut rule that the hearing officer ordinarily renders a final decision within ninety days after the hearing request, extended when the appellant requests or agrees or the Commissioner documents circumstances…

Connecticut Uniform Administrative Procedure Act appeal provision: a person who has exhausted administrative remedies and is aggrieved by a final decision may appeal to the Superior Court, generally within forty-five…

Official Department of Social Services hearing office guidance on who may request a hearing, including an authorized or legal representative, a community spouse on spousal asset and allowance determinations, and persons…

Connecticut definition of applied income: the income a Medicaid recipient must pay the nursing home for care after all appeals, with the amount reflecting any revision of the community spouse minimum monthly needs…

Connecticut fair hearing application rule: an aggrieved person, or the person's conservator, applies in writing over his or her signature stating in simple language why he or she is aggrieved, and the application must…

Delaware Register final order, effective October 10, 2012, amending Delaware Social Services Manual sections 5000, 5001, 5300, 5304.3, 5312, 5403 and 5500.

Delaware rule that for an individual 55 or older receiving long-term care facility services paid by the Department, a lien is created against the individual's real property, but only after notice and an opportunity for…

Delaware text allowing an applicant for or recipient of public assistance under chapter 5 or 6 of Title 31 to appeal an adverse administrative hearing decision to the Superior Court if the decision would result in…

Official Division of Social Services page stating that the Department of Health and Social Services offers a fair hearing to anyone dissatisfied with a decision to deny, suspend, delay, reduce or terminate benefits,…

Official OAH hearing request form for disputes with DHCF or its contractor about Medicaid coverage (not eligibility, which uses the DHS form), including denied or delayed services, equipment or supplies and denial,…

Official OAH hearing request form (revised November 2024) for appealing DHS decisions, including Medicaid financial eligibility and the EPD Waiver Program;

Official OAH guidance: the Department of Human Services decides Medicaid financial eligibility and DHCF decides coverage, and a person who believes DHS, DHCF or a Medicaid provider unfairly denied, reduced, delayed or…

An applicant, recipient or representative may request a hearing by any clear oral or written expression of a wish to present the case to a higher authority, which any administrative staff member must accept;

A hearing request on an adverse action concerning an application or a change in the amount, kind or conditions of assistance, or on a proposed termination or reduction, must be made within 90 days after the postmark of…

Text of the definitions for the District's Public Assistance chapter, which includes the hearing provisions in §§ 4-205.55, 4-205.59 and 4-210.01 through 4-210.12: public assistance means payment in money, medical care,…

Text of the Public Assistance Act notice rule: before discontinuing, withholding, terminating, suspending or reducing assistance or adding conditions, the Mayor must give timely notice (postmarked at least 15 days…

An applicant for or recipient of public assistance aggrieved by the Mayor's action or inaction is entitled to a hearing, must be notified of the right, and must receive reasonable notice of the time and place;

DCF's administrative policy chapter (about 148,000 characters, held as a reference).

Subsection (7) provides that, notwithstanding s. 120.57(1)(a), hearings conducted within the Department of Children and Families for the social and economic programs formerly administered by the Division of Family…

Text of the Administrative Procedure Act review provision: a party aggrieved by a final decision in a contested case may petition for judicial review, filed (unless another statute provides) in the circuit court for the…

Maryland Division of State Documents XML export of the whole chapter (about 38,000 characters).

COMAR text of Maryland's spousal impoverishment rules. Community spouse income is not deemed to the institutionalized spouse; income is attributed by the name on the payment or the trust terms;

COMAR text: the procedures for granting a Medical Assistance eligibility hearing to an applicant or recipient, and the status of benefits pending the hearing, are those in COMAR 10.01.04.

COMAR text of Maryland's liens and estate recovery. The Department imposes a pre-death lien on the real property of a long-term care patient who must contribute nearly all income to care, after notice and opportunity…

Official Maryland Department of Health eligibility manual section (revised July 2012) on fair hearings. It lists who may be an appellant's authorized representative: a spouse or domestic partner; a parent of a minor;

Official Office of Medicaid Board of Hearings request form: the appellant gives identifying information and member ID, the reasons for the appeal and supporting documents, elects either to keep prior benefits during the…

Official MassHealth operations memo (October 2023) stating that the revised Fair Hearing Request Form (FHR-1) reflects regulation changes extending the time to request a fair hearing from 30 to 60 days after notice, 130…

Massachusetts hearing right: an applicant, recipient or legal representative aggrieved by a failure to grant assistance, a failure to act on an application in time, or a withdrawal of assistance has a right to a hearing…

Massachusetts judicial review statute for final agency decisions in adjudicatory proceedings: where no other statutory review applies, review is by civil action in the Superior Court for the plaintiff's county, the…

MassHealth transmittal (December 23, 2022) with the revised pages of 130 CMR 610.015 and 610.091 through 610.093.

Massachusetts spousal impoverishment provision: in determining an institutionalized spouse's eligibility the division follows 42 U.S.C.

Massachusetts board of hearings statute: hearings are held by a referee at a location convenient to the appellant as adjudicatory proceedings under chapter 30A, the appellant may confront and cross-examine adverse…

In a contested case the parties are not bound by rules of evidence and may present oral and documentary evidence and cross-examine;

Official Office of Administrative Law guide: hearing requests are filed with the agency that sent the notice, not with OAL, which then receives the case, assigns an administrative law judge and sends a Notice of Filing…

In a contested case all parties must be afforded an opportunity for hearing after reasonable notice stating the time, place and nature of the hearing, the legal authority, the statutes and rules involved and the matters…

Office of Administrative Law notice readopting N.J.A.C. 1:10B, effective February 21, 2020 and expiring February 21, 2027: the special rules govern Medicaid applicant and recipient hearings transmitted to OAL, allow…

Official Division of Medical Assistance and Health Services communication: from July 1, 2026 DMAHS returns to the 20-day filing period of N.J.A.C.

Official Division of Medical Assistance and Health Services form: the applicant authorizes a named person or company to act in the Medicaid application and all eligibility reviews and to take any action necessary to…

Among the commissioner's duties, subsection e. requires assurance that any applicant, qualified applicant or recipient is afforded the opportunity for a hearing if the claim for medical assistance is denied, reduced,…

Department of Human Services publication of the entire Administration Manual chapter, far over 50,000 characters and held as a link. N.J.A.C.

In a statutory short form power of attorney, authority over "benefits from governmental programs or civil or military service" lets the agent enroll in, apply for, change or discontinue a benefit or program for the…

An applicant for or recipient of medical assistance, or any individual authorized to act on that person's behalf, may appeal to the department from a social services official's decision or failure to decide, and the…

Official City of New York 311 page: help is available for appealing public assistance cases including Medicaid, and a fair hearing before the State Office of Temporary and Disability Assistance may be requested by phone…

Unless a shorter time is provided in the law authorizing the proceeding, a proceeding against a body or officer must be commenced within four months after the determination to be reviewed becomes final and binding on…

An article 78 proceeding may raise only whether the body or officer failed to perform a duty enjoined by law, acted without or in excess of jurisdiction, made a determination in violation of lawful procedure, affected…

A Medicaid application may be made in writing to the social services official of the county where the applicant resides or is found, or to the Department of Health or its agent, by phone or online, with no in-person…

Text of New York's spousal impoverishment rules. An institutionalized spouse is one in a medical institution or nursing facility expected to stay 30 consecutive days, or receiving 1915(c) waiver or managed long-term…

Text of New York's Medicaid eligibility section (about 143,000 characters, so held as a reference).

A hearing request is any clear expression, oral, written or electronic, by the individual or authorized representative that the individual wants to appeal;

Limits the right to a state hearing to actions of ODJFS, ODM, the local agency or their agents, and lists the grounds, including an application denied, acted on erroneously or not acted on promptly, a proposed or actual…

The Bureau of State Hearings processes requests; a request made to the local agency must be date stamped and sent to ODJFS, Bureau of State Hearings (P.O.

Provides the state hearing, administrative appeal to the director, and court appeal structure that R.C.

Gives a medical assistance recipient the right to appeal a decision about eligibility for, or services under, a medical assistance program, and directs ODM to run an appeals process similar to R.C.

Official Department of Human Services guidance: an applicant or recipient notified that benefits are denied, reduced, suspended or terminated may request a fair hearing;

Regulation text: the freedom to request a hearing is a fundamental right not to be limited or interfered with, and every applicant or recipient of medical assistance may appeal a Departmental action or failure to act,…

Regulation text: the appellant may appear in person, represent himself or be represented, present evidence and witnesses, cross-examine, request subpoenas, and examine the case file and documents before and during the…

Regulation text, over 50,000 characters and held as a link: sets how a hearing is requested (usually in writing, signed, filed with the office that gave notice and forwarded to the Office of Hearings and Appeals within…

Regulation text: an Advance Notice is required before the CAO reduces or terminates MA payments or services, must be mailed at least 10 calendar days before the effective date, and must state the date by which an appeal…

Official Department of Human Services guidance: the Bureau of Hearings and Appeals hears denials, reductions, suspensions and terminations of Medical Assistance and nursing home level of care, under 55 Pa.

Requires HHSC to adopt uniform Medicaid fair hearing rules providing due process and the protections of 42 C.F.R.

HHSC's form page for Form H4800, which records that an applicant or client is dissatisfied with an agency action and has requested a fair hearing, documents the basis of the dissatisfaction, and notifies the agency of…

Citing 1 TAC 357.3, 357.7, 357.11 and 357.19, HHSC's hearings handbook lets Medicaid clients appeal a denial, reduction, suspension or termination, a failure to act with reasonable promptness, nursing facility transfer…

Lets an applicant or recipient appeal to HHSC an action or failure to act by a local eligibility office, requires HHSC to grant a hearing after reasonable notice, and lets the applicant, recipient or authorized agent…

Identifies the authority for HHSC fair hearings: 42 CFR 431.205 for Medicaid, Human Resources Code 31.034 as applied to medical assistance by 32.035, and the uniform fair hearing rules in 1 TAC chapter 357 administered…

Applies the Human Resources Code 31.034 appeal rights for financial assistance applicants and recipients to applicants for medical assistance under chapter 32. Read with section 31.034 and Government Code 532.0302;

Describes the impartial hearings officer and, citing 1 TAC 357.7 and 357.13, the agency's duties to submit an appeal within five days and to give the appellant and hearings officer the documents supporting its action…

An applicant or recipient dissatisfied with an MEPD eligibility decision (including Medicare Savings Programs) may appeal through HHSC's process and may in certain circumstances receive continued benefits until the…

An appeal may be filed by telephone, email, in person or other electronic means the agency supports, and any communication from the appellant or representative that clearly expresses a wish to present the case to a…

Official DMAS form (May 21, 2021 version) by which an appellant appoints an individual or organization as authorized representative for a Medicaid appeal;

Official DMAS appeal request form (May 21, 2021 version). It may be used, or a letter with the same information, to appeal by email, fax or mail with a copy of the notice attached;

A request for appeal must be filed within 30 days of the appellant's receipt of the adverse-action notice, receipt is presumed five days after mailing unless the appellant shows otherwise, and an appeal for failure to…

A non-attorney agent must be designated in a written statement signed by the appellant, although the Appeals Division may allow a family member or other person to represent an appellant who is physically or mentally…

The agency taking an adverse action must give written notice of the action and its effective date, the specific reasons, the supporting regulations or change in law, the right to an evidentiary hearing and the methods…

The community spouse resource allowance is the amount by which the greatest of the spousal resource standard, the spousal share (not above the maximum spousal resource standard), an amount set by a department hearing…

An individual may appeal a denied application, an action that adversely affects, reduces or terminates benefits, a denial or reduction of a requested service, a failure to act with reasonable promptness, an estate…

The community spouse monthly income allowance is the amount by which the greater of the monthly maintenance needs standard plus any excess shelter allowance, or an amount a hearing officer finds necessary because of…