Revision 10-4; July 16, 2010

 

How do I contact the Appeals Division in my area?

A contact list of all Hearings staff is posted to the Appeals Division website at http://hhscx.hhsc.state.tx.us/ChiefCounsel/Appeals/StaffList.pdf.

 

How do I file an appeal?

A client may request an appeal as a result of any of agency action. The directions for requesting an appeal are included with the notice of agency action. A client also may appeal if program fails to take action on a request for services. See Section 1200, Notice.

 

Will I be contacted for my scheduled hearing? How do I participate?

You will receive an appointment notice or an alert through the TIERS system from the hearings officer assigned to your appeal. The notice will state the date, time and location of the hearing. Most hearings are held via conference call, and in most cases you must call in to a conference line. The call-in information will be included in the notice. See Section 1410, Notice of Fair Hearing.

 

How long do I wait for a decision on my hearing?

Hearings officers must not take longer than 90 days (60 days for Supplemental Nutrition Assistance Program (SNAP)) from the date of the request for an appeal until initiating retroactive benefits. There are circumstances that could result in an extension of these timeframes. See Section 1711, Time Frame.

 

What can I do if I disagree with the hearings officer’s decision?

If you disagree with the hearings officer’s decision, you may request a review. However, a new decision is not issued in most cases. See Section 2300, Exception Process for Agency and Program Staff.

 

Can program staff resolve the issue on appeal before the actual hearing?

If during a review of the case prior to the hearing program staff discover an error, they may correct the error and notify the client.

If you provide additional information that you have not previously provided, you should receive a notice in response. If your case has been denied, you usually have the right to reapply and have your circumstances considered while waiting for the fair hearing. This does not affect the outcome of the fair hearing.

 

Am I required to send any information for my hearing?

Agency staff are required to send an evidence packet to both the hearings officer and the client before the hearing. See Section 1562.4, Agency Responsibilities.

 

How can I prepare for my hearing?

You should send all documents to be used at the hearing to both the hearings officer and the client at least 10 days before the hearing date. See Section 1562.4, Agency Responsibilities.

 

Can I speak to the hearings officer before the hearing?

The hearings officer may not speak to either party to the appeal before the hearing takes place, or after the hearing, but before issuing a written decision. See Section 1550, Private (Ex Parte) Communication.

 

What can I do if I do not understand the hearings officer’s decision?

Program staff may contact the hearings office if clarification is needed on a decision.

 

Will I receive information that will be discussed at the hearing?

If the hearings officer receives information from the client before the hearing, the documents will be forwarded to the agency representative for review.

 

If I get continued benefits with my appeal, do I have to repay any continued benefits I received?

The agency has the right to recoup any monies spent providing continued benefits if the hearing decision upholds the action taken by the agency. See Section 1320, Continued Benefits.

 

What are the time frames to file an appeal?

The client has 90 days from the date of the denial notice or agency action effective date to request a fair hearing. For exceptions to the 90-day time frame, see Section 1240, Time Period for Requesting a Fair Hearing.

 

What if the client missed the time frames for requesting an appeal?

The client may still request an appeal after the 90-day time frame has passed. The hearings officer will determine if the client had good cause for failure to file timely. Program staff should complete Form H4800, Fair Hearing Request Summary, and submit it to hearings staff within five days of the request. See Section 1240, Time Period for Requesting a Fair Hearing.

 

What if I do not attend the hearing?

If you do not attend the hearing, the hearings officer will address the absence in the hearing record and issue a reversed decision. See Section 1564.1, When the Agency Representative Does Not Appear for the Hearing.

 

Do I have to attend in person?

Most hearings are held by telephone; however, the client may request a face-to-face hearing. See Section 1562.4, Agency Responsibilities.

 

What if I cannot attend the scheduled hearing?

If you are unavailable to attend the hearing, you will need to work with your supervisor to ensure an agency representative is available.

 

What happens if I forget to tell the hearings officer something?

You may either call the hearings office at the telephone number listed at the bottom of the appointment notice or you may mail the additional information to the hearings officer at the address listed on the appointment notice.

 

What can I expect in a fair hearing?

The hearings officer will explain what will happen and swear everyone it. First, the agency representative will be given an opportunity to present the agency’s case and offer exhibits. Then the client will have an opportunity to ask questions and present his or her case.

 

What kinds of appeals are heard by the Fair and Fraud Hearings section?

The Fair and Fraud Hearings section handles TANF, SNAP, all Medicaid-funded services and all other agency programs that are required by state or federal law to provide the right to a fair hearing. See Section 1131, Authority and the Right to Appeal.

 

How do I ask for a pre-hearing conference?

You may request a pre-hearings conference by contacting the hearings office assigned to the appeal. See Section 1512, Pre-hearing Conference — General.

 

How long does a hearing last?

The length of the hearing depends on the complexity and type of issue on appeal. You should plan on a minimum of one hour. If it is anticipated that the hearing will last longer, you will be notified by the hearings officer during the hearing.

 

How do I get a copy of my case file?

The client is eligible to receive a copy of their entire case file before the hearing, upon request.

 

Are program staff allowed to work on any new actions while an appeal is pending?

Program staff may process any new actions, such as processing a new application or a reported change.

 

Frequently Asked Questions—Client

 

How do I contact the Appeals Division in my area?

If you have received an appointment notice regarding your appeal, the contact information is at the bottom of the page. If you have not received a notice, you may contact 2-1-1 or your caseworker to obtain the telephone number for the Appeals Division in your area. Appeals are heard by hearings officers across the state.

 

How do I file an appeal?

If you have received a notice of agency action, instructions for requesting an appeal are included on the notice. If you have not received a notice, you may contact 2-1-1 or your caseworker. An appeal may be requested in person, by telephone or mail. A client also may appeal if program fails to take action on a request for services. See Section 1200, Notice.

 

Will I be contacted for my scheduled hearing or how do I participate?

You will receive an appointment notice from the hearings officer assigned to your appeal. The notice will state the date, time and location of the hearing. Most hearings are held by telephone and in most cases; you must call in to a conference line. The call-in information will be included in the notice. See Section 1410, Notice of Fair Hearing.

 

How long do I wait for a decision on my hearing?

Hearings officers must not take longer than 90 days (60 days for Supplemental Nutrition Assistance Program (SNAP)) from the date of the request for an appeal to issue a decision. There are circumstances that could result in an extension of these time frames. See Section 1711, Time Frames.

 

What can I do if I disagree with the hearings officer’s decision?

You may request an administrative review if you do not agree with the hearings officer’s decision. Decisions are reviewed and a new decision is issued. See Section 2100, Process and Time Frames for Administrative and Judicial Review.

 

Can program staff resolve the issue on appeal before the actual hearing?

If during a review of the case prior to the hearing program staff discover an error, they may correct the error and notify the client.

 

If you provide additional information that you have not previously provided, you should receive a notice in response. If your case has been denied, you usually have the right to reapply and have your circumstances considered while waiting for the fair hearing. This does not affect the outcome of the fair hearing.

 

Can I have a pre-hearing conference?

The hearings officer may schedule a pre-hearing conference if it is necessary to resolve issues before the hearing. See Section 1512, Pre-hearing Conference.

 

Am I required to send any information for my hearing?

You are not required to send any information. If you have any documents that prove your side, you may send them to the hearings officer before the hearing. See Section 1562.1, Appellant’s Rights.

 

How can I prepare for my hearing?

You can review the documents the agency representative will be using at the hearing. If you have any documents you would like the hearings officer to consider, send them to the hearings officer before the hearing. See Section 1562.1, Appellant’s Rights.

 

What do I do if I need interpreter services, sign language assistance or other special accommodations?

You should let the hearings officer know before the hearing that you will need assistance in any of these areas. See Section 1562.3, Appellant’s Responsibilities.

 

Can I bring my child as a interpreter?

You may bring your child to assist you with presenting your case. HHSC provides qualified interpreters at hearings, when needed. See Section 1580, Interpreters.

 

Can I speak to the hearings officer before the hearing?

The hearings officer may not speak to either party to the appeal before the hearing takes place, or after the hearing, but before issuing a written decision. This ensures a fair and unbiased hearing for all involved parties. See Section 1550, Private (Ex Parte) Communication.

 

What can I do if I do not understand the hearings officer’s decision?

The cover letter instructs you to call the hearings officer if you do not understand the decision. See Section 1721, Components of a Hearing Decision.

 

Will I receive information that will be discussed at the hearing?

Yes, the agency representative is required to send a copy of the documents to be used at your hearing to both you and the hearings officer before the hearing. See Section 1562.1, Appellant’s Rights.

 

Can I apply for benefits if I have an appeal pending?

Yes, you may apply for benefits at any time. You do not have to wait for your hearing or a hearing decision

 

Can I receive continued benefits pending the outcome of my appeal?

Depending on the program and when you request an appeal, you may be able to receive continued benefits pending the outcome of the appeal. See Section 1320, Continued Benefits.

 

If I get continued benefits with my appeal, do I have to repay any continued benefits I received?

The agency may ask you to pay back the money spent providing continued benefits if the hearings officer upholds the action taken by the agency. See Section 1220, Content of Notice.

 

Can someone represent me in a hearing? Can others participate with me at the hearing?

You have the right to ask someone to represent you at the hearing and to help you state your case. You also may invite other individuals who may provide additional information. See Section 1530, Attendance at Hearing, and Section 1562.1, Appellant’s Rights.

 

What are the time frames to file an appeal?

You have 90 days from the date of the denial notice to request a fair hearing. For exceptions to the 90-day time frame, see Section 1240, Time Period for Requesting a Fair Hearing.

 

What if I missed the time frame for requesting an appeal?

You still may request an appeal after the 90-day time frame; however, you will need to tell the hearings officer why you failed to request the appeal within the time frames. The hearings officer will decide if you had good cause for not submitting the appeal timely. See Section 1240, Time Period for Requesting a Fair Hearing.

 

What if I do not attend the hearing?

If you do not attend the hearing, the hearings officer will dismiss the request for a fair hearing. You will have 30 days from that date on the decision to ask the hearings officer to reopen your appeal. You will need to explain in writing why you did not attend the hearing. See Section 1564.2, When the Appellant Does Not Appear for the Hearing, and Section 1724, Dismissals.

 

Do I have to attend in person?

Most hearings are held by telephone. The appointment date, time and call-in number are included in the appointment notice. You may request a face-to-face hearing. See Section 1411, Date and Location.

 

What if I cannot attend the scheduled hearing?

Most hearings are held by telephone. The appointment notice contains the date, time and location of the hearing. If it is a telephone hearing, the number to call for the hearing will be in the notice. See Section 1410, Notice of Fair Hearing.

 

If you know you will be unavailable for the date and time stated in the appointment notice, you can call the hearings office at the telephone number listed at the bottom of the appointment notice to ask that the hearing be rescheduled. You also can send a written request to the hearings officer using the form provided with your appointment notice.

 

What happens if I forget to tell the hearings officer something?

You either may call the hearings office at the telephone number listed at the bottom of the appointment notice or you may mail the additional information to the hearings officer at the address listed on the appointment notice. If the hearings officer determines the information is relevant to the case, the information will be shared and the hearing will may be reconvened.

 

What can I expect in a fair hearing?

Once everyone is in attendance, the hearings officer will explain what will happen and swear in everyone. Then the agency representative will explain the action they took on your case. You will then have a chance to ask questions and explain why you disagree with the action or inaction taken by the agency.

 

What kinds of appeals are heard by the Fair and Fraud Hearings section?

The Fair and Fraud Hearings section handles TANF, SNAP, all Medicaid-funded services and all other agency programs that are required by state or federal law to provide the right to a fair hearing. See Section 1131, Authority and the Right to Appeal.

 

How do I know the appeal process is fair?

The hearings officer is required by state and federal law to be impartial and must be a person who has no prior knowledge of the case. The hearings officer may only consider evidence and testimony provided at the hearing when making a decision on the case. See Section 1721, Components of a Hearing Decision.

 

How many times can I appeal the same issue?

If you are not satisfied with the action taken by the agency, you may request an appeal. If you disagree with the hearings officer’s decision, you may request an administrative review. If you disagree with the outcome of the administrative review, you may request a judicial review by filing in the district courts in Travis County. See Section 2100, Process and Timeframes for Administrative and Judicial Review.

 

How do I ask for a pre-hearing conference?

You may contact the hearings staff by calling the telephone number at the bottom of the appointment notice and asking for a pre-hearings conference. The hearings officer may schedule a pre-hearings conference to resolve issues. See Section 1512, Pre-hearing Conference.

 

How long does a hearing last?

The length of the hearing depends on the complexity and type of issue on appeal. You should plan on a minimum of one hour. If it is anticipated that the hearing will last longer, you will be notified by the hearings officer during the hearing.

 

Do I have to have an attorney?

No, you do not need to have an attorney. You may have an attorney represent you at the hearing at your own expense. See Section 1562.1, Appellant’s Rights.

 

Can I record the hearing?

Yes, you may record the hearing. However, the “official” record of the hearing is the recording made by the hearings officer. See Section 1530, Attendance at Hearing.

 

How do I get a copy of the hearing recording?

You may request a copy of the hearing recording from the hearings officer. See Section 1530, Attendance at Hearing.

 

How do I get a copy of my case file?

A copy of the documents used to make the decision on the issue on appeal will be sent to you before the hearing. To obtain a copy of your entire case file, you may contact your caseworker, your caseworker’s supervisor, the ombudsman’s office or the hearings officer.

 

Are program staff allowed to work on any new actions while an appeal is pending?

Program staff may process any new actions, such as processing a new application or a reported change.

 

Can I appeal a collection notice?

You can appeal a notice of overpayment. See Section 1410, Notice of Fair Hearing.