Revision 18-1; August 20, 2018

 

How do I contact the Appeals Division in my area?

If you have received a notice of hearing regarding your appeal, the contact information is at the top of the page. If you have not received a notice, you may contact 2-1-1 or the Appeals Division at 512-231-5701. 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. You also may appeal if the agency fails to take action on a request for services.

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

You will receive a notice of hearing 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.

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.

When will I receive 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.

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. An administrative review is a review of the hearing record by a Health and Human Services Commission (HHSC) attorney. The attorney will issue a new decision after reviewing the record.
 
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 you.

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.  

Am I required to send any information for my hearing?

You are not required to send any information. If you have any documents that you would like the hearings officer to consider, you may send them to the hearings officer before the hearing.  

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.

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.

Can I bring my child as an interpreter?

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

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.

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

The cover letter sent with the hearing decision includes a phone number you may call if you do not understand the decision.

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.

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.

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.

What is the time frame to file an appeal?

You have 90 days from the date of the denial notice to request a fair hearing. If the agency that took action on your case is a managed care organization (MCO), you have 120 days to request a fair hearing from the date the MCO internal appeal has been completed.   

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 frame. The hearings officer will decide if you had good cause for not submitting the appeal timely.

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 the date of 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.

Do I have to attend in person?

Most hearings are held by telephone. The hearing date, time and call-in number are included in the notice of hearing.

What if I cannot attend the scheduled hearing?

Most hearings are held by telephone. The notice of hearing 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.

If you know you will be unavailable for the date and time stated in the notice of hearing, you can call the hearings office at the telephone number listed at the top of the notice of hearing to ask that the hearing be rescheduled. You also can send a written request to the hearings officer using the form provided with your notice of hearing.
 
What happens if I forget to tell the hearings officer something?

You may mail the additional information to the hearings officer at the address listed on the notice of hearing. If the hearings officer determines the information is relevant to the case, the information will be shared and the hearing 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 everyone in. 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?

Hearings officers hear appeals for programs administered by HHSC and HHS System agencies, including SNAP, Temporary Assistance for Needy Families (TANF) and Medicaid-funded services.  

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.

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.

How do I ask for a pre-hearing conference?

You may contact the hearings staff by calling the telephone number at the top of the notice of hearing and asking for a pre-hearing conference. The hearings officer may schedule a pre-hearing conference to resolve issues.

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, but you may have an attorney represent you at the hearing at your own expense. For free legal assistance, contact your local legal aid office.

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.

How do I get a copy of the hearing recording?

You may request a copy of the hearing recording from the hearings officer.

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.