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PROTECT YOUR MEDICAID RIGHTS

Linda Lowe
Georgia Legal Services Program
Last Revised: May 2005

PROTECT YOUR MEDICAID RIGHTS

If you have Medicaid problems, ask for a fair hearing.

If you have problems with Medicaid, you have rights:

● WRITTEN NOTICE.  You have the right to a written notice when the state plans to cut off your Medicaid, deny you services, or take any other action that is unfavorable to you.  The notice must include the reasons for the action.

● NOTICE BEFORE THE STATE CUTS OFF YOUR MEDICAID.  In almost all cases, you have the right to 10 days notice before the state cuts off your Medicaid.  Also, if the state finds you are not eligible for one type of Medicaid, it must look to see whether you are eligible for any other type. 

● A FAIR HEARING.  If you disagree with a decision the state makes, you have the right to a fair hearing.   Call your county Department of Family and Children’s Services to ask for a fair hearing.

What is a fair hearing?

A fair hearing is a chance to get state officials to change their decision about your case.  An independent administrative law judge from the Office of State Administrative Hearings will come to your county.  The judge will listen to you, listen to Medicaid workers, read the law, and write a decision.  You can represent yourself or you can take a lawyer or other person to represent you.  The judge should send you a written decision within 90 days after you ask for the hearing.  Sometimes your problem can be solved even before the hearing.  Make sure you really agree with what the state is doing before you cancel the hearing.  If you are not sure, it is better to go to the hearing and talk to the judge.

How do I get a fair hearing? 

You usually have 30 days from the date on the notice to ask for a fair hearing.  If you ask for a hearing within 10 days, you can keep getting Medicaid while you appeal.   (If you lose, the state could ask you to pay back benefits it paid while you appealed.)

Call or visit your county Department of Family and Children’s Services (DFCS) to ask for a fair hearing.  You must send a written request within 15 days  after you first ask for the hearing if you did not do it in writing.

Send your request for a fair hearing to:

Department of Human Resources
Legal Services Section
2 Peachtree Street, NW - 29th Floor
Atlanta, Georgia 30303-3159
404-657-1123 (fax)

Times when you may want to ask for a Medicaid fair hearing:

• You apply for Medicaid, but the State decides you are not eligible
• You are not allowed to apply for Medicaid when you ask
• The State takes more than 45 days to make a decision on your application (90 days if the State must decide whether you are disabled)
• Your Medicaid is cut off
• Your doctor, pharmacist, transportation broker, Ga. Better Health Care provider, dentist, or another health care provider tells you Medicaid will not pay for a service you need
• Medicaid does not pay for a service you have already received
• The state decides you cannot have nursing home care or services under the Community Care Services Program, the Mental Retardation Waiver, the Independent Care Waiver, or another waiver program
• Services Medicaid has been paying for are stopped and you believe they should not be stopped
• You have any other problem with Medicaid        

For more information please contact the Atlanta Legal Aid Society or Georgia Legal Services Program office nearest you.

For Clayton, Cobb, Dekalb, Fulton, and Gwinnett Counties, call Atlanta Legal Aid Society: 404-524-5811

For all other counties, call Georgia Legal Services Program:  1-800-498-9469 (toll free), or, f or the Hearing Impaired, call: TDD 1-800-255-0056

For Seniors age 60 and older, call the Georgia Senior Legal Hotline: 1-888-257-9519 (toll free)

Linda Lowe