117-1          FAIR HEARING REQUEST

A request for a fair hearing is a clear expression by the client or client's legal representative of their desire to present their grievance and have their case reviewed by an impartial party outside the Division. Any individual or household that disagrees with any action taken by the Division which affects their program participation or benefit level may request a fair hearing.

117-1 A.      REASONS FOR REQUESTING A FAIR HEARING

Applicants or recipients may request a fair hearing if:

1. Their application for benefits under any assistance program administered by DPADivision of Public Assistance is denied;
2. Their application or claim for an increase in the amount of assistance is denied or not acted on within the required time limitations;
3. Their request for the addition of one or more individuals to their case is denied or not acted upon within the required time limitations;
4. Their assistance or level of benefits is reduced, or their benefits are terminated;

Note:

When benefits are reduced or terminated due to a mass change, a client may be granted a hearing only if the issue concerns program eligibility, the computation of benefits, or the agency's interpretation of state or federal law.

5. The form of payment is changed to a protective payee, vendor, or two-party payment;
6. Their request for restoration of lost benefits is denied;
7. They disagree with the reason or amount of an established overpayment claim; or
8. Their request for a covered Medicaid services is denied.

117-1 B.      HOW TO REQUEST A FAIR HEARING

A fair hearing request may be made by an applicant or recipient, or a legal representative acting on their behalf. The request for SNAPSupplemental Nutrition Assistance Program and Medicaid may be made to any employee of the Division in person, by telephone, or in writing; requests for all other programs must be made in writing, including Child Care Assistance Program. Written requests may be hand-delivered, faxed, emailed, or mailed to any DPADivision of Public Assistance office. Fee Agents may receive the request and forward them to the appropriate DPADivision of Public Assistance office.

When a request for SNAPSupplemental Nutrition Assistance Program is received in person or by telephone, the request must be placed in writing using the Fair Hearing Request form (GEN 85Fair Hearing Request form). Staff is required to assist clients in completing this form, if needed. Staff must also assist clients in obtaining representation and, when necessary, locating and securing an interpreter.

The office that receives the fair hearing request must immediately submit it online at http://dpaweb.hss.state.ak.us/ by selecting the Fair Hearing Referral link in the Quicklinks section located on the right side of the web page, provide a copy of the request to the supervisor of the caseworker who processed the case that led to the fair hearing request, and enter a case note following Addendum 109 C instructions.

A copy of the fair hearing request and related documentation should be uploaded into the referral as a file attachment. If the hearing request relates to an overpayment claim, the Fair Hearing unit will notify the Claims Unit in Juneau.

When submitting the Fair Hearing Request, staff will need to complete all of the required fields (which include the client's first and last name, DPADivision of Public Assistance case number(s), programs involved, date the request was submitted, and the name of the staff member submitting the Fair Hearing request) on the web form and upload the Date Stamped Fair Hearing request form and supporting documentation by using "Add File." Once all the fields are completed, select the Submit Button.

117-1 C.      FAIR HEARING REQUEST DATE

The date the Division receives the request in any of its offices is considered the fair hearing request date. Staff are required to complete the Fair Hearing Request form (GEN 85Fair Hearing Request form) for Supplemental Nutrition Assistance Program (SNAPSupplemental Nutrition Assistance Program) fair hearing requests received in person or by telephone. If the request is made in person, the client should also sign the form. The fair hearing request must be date stamped the same day it is received in any DPADivision of Public Assistance office. This date will be referred to as the date of the request.

Requests received by a Fee Agent must be promptly sent to the appropriate district office. The date the request is received in the DPADivision of Public Assistance office is considered the fair hearing request date.

117-1 D.      TIME LIMITS TO REQUEST A FAIR HEARING

Clients must request a fair hearing within the time limits established for each program. If the agency determines a fair hearing request was not received timely, it is forwarded to the hearing authority for a ruling on its timeliness.

1. Fair hearing requests relating to Temporary Assistance, Medicaid, Adult Public Assistance, General Relief Assistance, and Child Care Assistance programs must be made in writing and received by the division within 30 days from the date the agency sent a correct notice of adverse action.

2. Fair hearing requests related to Medicaid can be made by telephone, in writing, or in person within 30 days from the date the agency sent a correct notice of adverse action.
3. Fair hearing requests relating to the Supplemental Nutrition Assistance Program (SNAPSupplemental Nutrition Assistance Program) can be made by telephone, in writing, or in person and must be received by the division within 90 days of the effective date of the proposed action.
4. Clients are also allowed to request a fair hearing at any time within a Supplemental Nutrition Assistance Program (SNAPSupplemental Nutrition Assistance Program) certification period to dispute the current level of benefits.

Example:

A household's Supplemental Nutrition Assistance Program case was approved in January and is certified through June. The client requested a fair hearing in May because he feels he is not getting the right amount of SNAPSupplemental Nutrition Assistance Program benefits. Even though the action establishing the amount of benefits was taken over 90 days before this request, a hearing is granted.

5. A request for a fair hearing to dispute a denial of restored SNAPSupplemental Nutrition Assistance Program benefits is granted if the hearing is requested within 90 days of the date of the denial, and the benefits were lost less than a year before the date of the request for restoration.

117-1 E.      FAIR HEARING REQUESTS FOR DENIAL OF MEDICAL COVERAGE

Fair hearing requests regarding denial of medical coverage for clients eligible for Medicaid (such as denial of specific services and denial of admission or continued stay in a nursing home) are normally handled by the Division of Health Care Services (DHCSDivision of Health Care Services). However, these requests must still be sent to the DPADivision of Public Assistance hearing representative. Copies of the request must also be retained in the case file.

The DPADivision of Public Assistance hearing representative will forward the hearing request to DHCSDivision of Health Care Services. No further action is required unless DPADivision of Public Assistance is contacted by a DHCSDivision of Health Care Services representative or the hearing authority. The hearing authority will act as coordinator for these DHCSDivision of Health Care Services fair hearing requests. All questions are to be directed to DPADivision of Public Assistance DOSTDivision Operations Support Team office.