The Department of Health and Social Services (DHSS) provides an opportunity for a fair hearing to any person who is dissatisfied with a decision to deny, suspend, delay, reduce, or terminate benefits. A fair hearing gives applicants and recipients an opportunity for an impartial, objective review of actions taken by DHSS. When we notify anyone of any action affecting their benefits, we provide a written notice of the opportunity for a fair hearing and the method by which a hearing can be requested. Appellants can appear for a hearing in person or they can be represented by legal counsel or by another person at a hearing.

A request for a hearing must be made in writing. When someone asks for a hearing, we prepare and submit a hearing summary to the State Hearing Office of the Division of Social Services. The fair hearing summary gives the factual and legal reason(s) for the action under appeal. When the hearing summary is received, the Hearing Office sets a date for the hearing and notifies all parties, including witnesses, by certified mail of the date, time, and place of the hearing.

Before the hearing, the applicant or recipient and his/her representative can ask to look at and copy the documents and records the State or its agent (such as a Managed Care Organization) will use at the hearing. Such requests should be made to the office where the action under appeal was taken. There is no charge for copies of records and documents needed to prepare a case for a fair hearing.

At the hearing the individual has the opportunity to:

1. Examine case records and documents;
2. Present his/her case by him/herself or with the aid of a representative or counsel;
3. Bring witnesses;
4. Submit evidence to establish all pertinent facts and circumstances;
5. Advance any argument without interference;
6. Question or refute any testimony or evidence including an opportunity to confront and cross-examine adverse witnesses;
7. Use interpreters or mechanical facilities to overcome language or other communication handicaps;
8. Withdraw the request for a hearing at any time.

Decisions of Hearing Officers are based exclusively on evidence introduced at the hearing. The decision of the Hearing Officer is issued within 30 days from the date of the hearing. The decision of the Hearing Officer is the final decision of the Department of Health and Social Services. If an applicant or recipient disagrees with the decision of the Hearing Officer, he/she may ask for judicial review. In order to have a review of the decision in Superior Court, a notice of appeal must be filed with the clerk (Prothonotary) of the Superior Court within 30 days of the date of the decision. An appeal may result in a reversal of the Hearing Officer’s decision.

Hearing decisions regarding Medical Assistance

Names of appellants have been removed from all hearing decisions posted here, either by being redacted or by substituting a pseudonym.