Eligibility Online Manual
M1900 Informal Conferences/Administrative Hearings
Purpose: This section will provide information on Informal Conferences and Administrative Hearings.
Current Policy Effective Date: January 1, 2014
Date Last Reviewed: September 4, 2014
Previous Policy: July 1, 2012
POL M1900: INFORMAL CONFERENCES/ADMINISTRATIVE HEARINGS
1. Applicants Or Clients May Request Administrative Hearing
Applicants or clients may request an Administrative Hearing when an adverse action is taken to deny, close, suspend or reduce benefits.
2. Applicants Or Clients Must Request Hearing Within 30 Days
Applicants or clients must provide a verbal or written request for a hearing within 30 days of the date printed on the notice of adverse action.
3. Applicants Or Clients May Be Represented
Applicants or clients may be represented by an attorney, relative, friend or other spokesperson.
4. Formal Conference May Be Conducted
Formal Conferences must be conducted within three days from receipt of a request for an Administrative Hearing, unless waived by the applicant, client or the client’s representative.
5. Administrative Hearings May Be Denied
An Administrative Hearing may be denied for the following reasons:
Adverse action is due to a Federal or State law requiring an automatic change that affects some or all clients.
A determination was made that an adverse action was not taken by the WDH, Long Term Care Unit or the Customer Service Center.
The request for the hearing was not received within the required timeframe.
The adverse action was taken by the Social Security Administration.
The applicant, client or representative will be notified of the approval or denial of their request for hearing.
6. Clients Benefits May Continue Pending Administrative Hearing
Continue Medicaid benefits when the client requests a hearing before the effective date of the adverse action, unless the request for hearing is denied.
7. Administrative Hearings Must Be Referred To The Office Of Administrative Hearings (OAH) By The WDH Within 10 (Ten) Days Of Request
8. Administrative Hearings Must Be Held Within 40 Days Of Request
Defining Requirement: 42 CFR 431, Subpart E