A Fair Hearing

A Fair Hearing

May 2017

By Carl A. Glad, Esq, Partner Law Offices of Kurt M. Ahlberg LLC

To say the Medicaid application process can be frustrating would be a great understatement.  Receiving a letter with the statement “NOTICE OF DENIAL” can be defeating.

This letter informs applicants that they are not eligible in whole or in part for long-term care.  There are many reasons for a denial, but most relate to the amount of assets of either the applicant or their spouse.  The immediate concern is certainly: “I know I should qualify, what do I do and how can I fix this.”

Under the law, you are entitled to a hearing to contest the denial.  The Connecticut Department of Social Services (DSS) will hold this hearing upon the applicants request to review the decision.  This hearing is called a “Fair Hearing.”  Once you request a hearing, DSS will send a letter with the date of your hearing and will also send a document outlining the reason for the DSS denial along with supporting evidence.

At the actual hearing, the applicant should present their position and the reason they should have been approved along with supporting evidence.  The DSS caseworker that issued the decision will also present the reason for the DSS denial.  A hearing officer presides over the hearing and will issue a decision.  Most often the hearing is held through video-conference with the hearing officer sitting at another location.  The decision will not be made at the hearing.  A final written decision will be mailed to the applicant.

It is important to be prepared for these hearings.  You must come with all the relevant evidence to support your argument.  The hearing officer will examine your evidence and your statements to determine if an error or oversight was made that resulted in the denial.  Legal representation is not required, however, attorneys that work in this field, have experience in these proceedings and understand the Uniform Policy Manual and relevant State and Federal laws.

There is also an opportunity to resolve your matter before the hearing.  You can provide the DSS caseworker with new evidence prior to your hearing.  The caseworker will evaluate this evidence.  If the caseworker or their supervisor agrees with your position, they will retract the denial and recalculate your benefits.

Of course the best way to avoid all of this is to hire an experienced attorney at the beginning of the application process.

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