All Medicaid Programs |
Obsolete Policy |
Contact DWS Program Specialist for previous policy
Applicants and recipients have the right to ask for a fair hearing if they disagree with the agency's decision about eligibility for Medicaid benefits.
An applicant or recipient must request a hearing in writing or orally within 90 days of the date on the notice with which he disagrees.
The applicant or recipient must submit a written or verbal request to the Department of Workforce Services Fair Hearing Team. The client must make the request by the close of business on the 90th day, or if the 90th day is a non-business day, by the close of business on the first business day following the 90th day.
If the agency denies a request to waive a penalty period due to undue hardship, the client has 90 days from the date on the notice denying the undue hardship to request a fair hearing.
Recipients receive continued medical benefits pending a hearing decision if they request a fair hearing before the effective date of the action or within 10 calendar days of the mailing date of the notice. See 125-3
The client must repay any benefits received pending the hearing decision if the hearing decision upholds the agency action. See 125-3
A client has the right to refuse continued benefits pending a hearing decision.
When the Medicaid Disability Review Office decides a person is not disabled, the individual may request a fair hearing. The individual may also ask for a reconsideration of the disability decision as part of the fair hearing request. Reconsideration is a good idea when the individual has medical evidence that was not available before.
When the eligibility agency denies or stops medical assistance because of a denial of disability from Social Security (SSA), the Medicaid agency cannot conduct a hearing based solely on the SSA decision. The individual can only appeal SSA’s denial of disability through the Social Security office. See Section 125-3 for policy on continued benefits. The client may request a hearing when there is new medical evidence not considered for the SSA decision. See Section 303-3 A #5.
The eligibility agency cannot hold hearings concerning the spousal resource assessment until the institutionalized person applies for Medicaid.
When a recipient requests a hearing to increase the spousal resource allocation for a community spouse of an institutionalized spouse, the "income first" rule applies to the hearing decision. See sec. 373-2
A client, a client’s spouse, a parent of a minor child or an authorized representative may request a hearing.