Requesting
a Fair Hearing
What
happens if my Medicaid is denied or terminated?
This is a very good question.
Many people do not know that they have a right to ask for a fair hearing
if things aren’t going the way that the law says they should be.
What is a fair hearing?
A fair hearing is a way
you can appeal if you don’t agree with a decision made about your Medicaid
benefits or your medical care.
You can request a fair
hearing if:
-
Your Medicaid has been denied
or terminated.
-
You have been wrongfully
denied a medical service.
-
A medical service you were
receiving has been wrongfully stopped or reduced.
|
How do I request a fair
hearing?
You can request a fair hearing
in writing to the:
Division of Hearings
and Appeals
P.O. Box 7875
Madison, WI 53707
You can also request a fair
hearing in person at your county Human Services Department. You can also
fax a hearing request to Madison at 608-264-9885. Legal Action of
Wisconsin can help you file for a fair hearing (414-278-7722).
Is there a time limit
for requesting a fair hearing?
You
have 45 days from the date of a notice of denial or 45 days from the date
of termination or reduction of your benefits or services to request a fair
hearing. However, in certain cases it is important to request a fair hearing
as soon as possible.
Note: If a notice was not sent, you can appeal at any time.
Will my benefits stop
if I request a fair hearing?
If you request a fair hearing
before the date of termination of your Medicaid or before a medical service
is reduced or terminated, your Medicaid benefits or services cannot be
stopped until a fair hearing decision has been issued.
| Example: If you receive
a notice telling you that your Medicaid case will close on April 1 and
you request a fair hearing before April 1, your Medicaid must continue
until a hearing decision is made. If you do not appeal by April 1, your
Medicaid will close on April 1, but you still have 45 days from April 1
to request an appeal. You must appeal by May 15 or you will lose your right
to appeal. If you win your fair hearing, the county will be ordered to
open your Medicaid case back to April 1. |
