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Attention Medicaid Participants: Eligibility Renewals Restarted April 1, 2023
The Division provides an opportunity for a fair hearing to any individual who is dissatisfied with a decision of the Division (i.e., to deny, suspend, delay, reduce, terminate, or sanction a Division-issued benefit, etc.). The purpose of a fair hearing is to give all applicants and recipients an opportunity for an impartial, objective review of actions taken in programs administered by the Division. Every person is informed in writing at the time of application and at the time of any action affecting their benefits of their right to a fair hearing and the method by which they may request a hearing. They may appear for the hearing by themselves or may be represented by counsel or by another person at the hearing.
Requests for a hearing should be made in writing. When someone requests a hearing, Division staff prepares and submits a hearing summary to the State Hearing Office. The fair hearing summary states the factual and legal reason(s) for the action under appeal. Upon receipt of the hearing summary, the Hearing Office sets a date for the hearing and notifies all parties, including witnesses, of the date, time, and place of the hearing by letter.
Before the hearing, the applicant or recipient and his/her representative can ask to look at and copy the documents and records the Division or its agent will use at the hearing. Such requests should be made to the Division’s office where the action under appeal was made. There is no charge for copies of records and documents requested for a fair hearing.
At the hearing the individual has the opportunity to:
Examine the case records and documents;
Decisions of the Hearing Officer are based exclusively on the evidence introduced at the hearing. The decision of the Hearing Officer is issued within 30 days from the date the hearing is conducted. The decision of the Hearing Officer is the final decision of the Division. 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 State Hearing Officer’s decision.
To view recent DSS Fair Hearings,click here.
To view DMMA's Medicaid Fair Hearing decisions,click here.