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   OSAH Form 1 - DFCS Request for Fair Hearing with Office of State Administrative Hearings This link opens a PDF file in a new window.  If you do not have an accessible Acrobat Reader, a link is provided at the bottom of this page. (Separate Website)
When you have been denied Medicaid or had your Medicaid Benefits lowered or terminated, you can ask for a fair hearing. You can fill out a fair hearing request letter and mail it or deliver it to your local Division of Family and Children Services (DFCS) office to begin the process. When DFCS gets your letter asking for a fair hearing, they use this form to process your appeal with the Office of State Administrative Hearings (OSAH). You can give DFCS this form and ask them to fill it out and send it to OSAH and to the Department of Human Resources Legal Services to process your appeal.
By: Georgia Department of Human Resources

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