Fair and Fraud Hearings

Fair hearing activities are based on federal and state statutes, rules and regulations. When state-issued benefits or services are issued, ended, interrupted, denied or reduced, you'll receive a Notice of Case Action. This notice will describe the action and the reason the agency took the action.

If you don't agree with the action taken on your benefits, you can request an appeal for a fair hearing. Appeal requests have to be made within 90 days from either the date of the case action or the effective date that is on the Notice of Case Action. You may also ask for an appeal on a "non-action," which means you have submitted an application or change to your benefits or services, but the agency has not completed the action in the required time.

Requesting an Appeal

The fair hearing process begins with asking for an appeal, which can be requested for many of the actions or inactions that happen to SNAP food benefits, Temporary Assistance for Needy Families, Medicaid, or other state-issued benefits or services. You can ask for an appeal in writing, by calling 2-1-1 or by speaking to your local caseworker.

Once Texas Health and Human Services receives the appeal request:

  • We forward it to the HHS Hearings Department.
  • Your appeal will be assigned to a hearing officer.
  • A fair hearing will be scheduled with your assigned officer
  • A Notice of Hearing will be mailed at least 14 days before the hearing date.

Most of the hearings in Texas are done by conference call. The Notice of Hearing will have the date and time of the hearing, a toll-free number and an access code for you to participate in the hearing. You must call in on time because the hearing officer will close the hearing seven minutes after it starts. If you don't call in before the hearing officer closes your hearing, he’ll dismiss your hearing for failure to appear.

Fair Hearing Preparation

Before the hearing, the agency or managed care organization that took the action on appeal will send you all the information they’ll use in the fair hearing. You’ll receive policy excerpts and documents to support the action.

It’s important to look over this information and think of any questions or concerns you may have. If you have any documents you want to use in the hearing, send them to the hearing officer as soon as possible. You can find the hearing officer’s contact information on the Notice of Hearing. The hearing officer will send your information to the agency that took the action so they can review it before the hearing.

During the Hearing

The hearing officer will open the hearing and let everyone know it’s being recorded. Then:

  • Everyone will be placed under oath, and any documents or evidence will be submitted into the hearing record.
  • The agency or managed care organization representative will begin their testimony first since they must prove the action they took followed policy. This is called the “burden of proof.”
  • After the agency testifies, you can ask the agency any questions about their testimony.

After the cross-examination of the agency, you’ll begin your testimony. When you’ve finished, the agency representative can ask you questions. The hearing officer may ask questions of you or the agency representative to get all the information they need to make a decision on the case. Once the hearing officer has all the information, they will close the hearing record and end the call.

Hearing Officer’s Role

The hearing officer has an important role to play in the hearing process as an unbiased moderator. This means they can only consider the information presented in the hearing to decide which facts are relevant to the case. They must consider information that’s relevant to the action taken and the timeframe of that action. This means events happening after the agency action aren’t always considered during the hearing.

The hearing officer doesn’t have unlimited power to grant benefits or make changes to benefits. They must follow the same policies and laws that govern the benefits.

After the Fair Hearing

The hearing officer has anywhere from 60–90 days from the appeal request date to issue a decision, depending on the program or benefits. They will either issue a sustained decision, meaning the action by the agency was upheld, or a reversed decision, meaning the agency’s action was not correct and they must correct it.

If you aren’t satisfied with the hearing officer’s decision, you can ask for an administrative review or procedural review. This means an independent HHS attorney will review the hearing information and make sure the hearing officer followed policy when reaching their decision.

If you aren’t satisfied with an administrative review, file a judicial review in the Travis County District Courts for a judge to review the decisions of the hearing officer and the HHS attorney.