There’s avenues to finding a ‘fair hearing’

Many people as they get older receive programs and services from different government agencies.

Maybe you have Medicaid in addition to Medicare to help with medical bills. Long-term Medicaid that pays for services in your home or nursing home expenses. You may receive SNAP to help pay for groceries or HEAP to help with your heating bills or to replace/repair your furnace. Often we hear complaints from older adults that services were cut at their annual review or do not meet their needs.

So this month, I wanted to explain the process to have your services reviewed. It is called a “fair hearing”. If you receive any government assistance and you do not agree with the amount of the payment or service, you can request a “fair hearing.”

So what is a fair hearing? A fair hearing means that your benefits will be reviewed by a judge. The judge will review all the information and make a determination as to what amount of benefits you are entitled to. These administrative law judges are usually with the NYS Office of Temporary and Disability Assistance at the state or if it is a federal program like Social Security, it would be a federal administrative law judge. One of the reasons I came to Chautauqua County years ago was my aunt, Judge Marge, who was a federal Administrative law judge for Social Security. She held hearings in Jamestown when people were denied SSI or SSD and wanted that reviewed. At the hearing, you can tell the judge why you think the evaluation was wrong or present additional information about your circumstances. Most fair hearings for state programs like SNAP, HEAP, and Medicaid are fairly simple and do not require legal representation but I certainly recommend you bring a family member or an advocate like a social worker.

How do you request a fair hearing? After you enroll in a program, like Medicaid, SNAP, or HEAP, you will usually receive an award letter. It will tell you the amount of service and/or award and include information about a fair hearing. It will say something like, “If you do not agree with this, you can file for a fair hearing.” It should include a phone number, fax, e-mail, and address so you can call, e-mail or write to request a fair hearing. Make sure you include the case number, your full name and address, and any other information that is requested. If you notice your benefits were changed and you did not receive a letter telling you this, you can also request a fair hearing. Simply contact the NYS Office of Temporary and Disability Assistance through their website at https://otda.ny.gov/hearings or call 800-342-3334 or fax 518-473-6735 or write to PO Box 1930, Albany N.Y. 12201.

If you have a Managed Medicaid Long-term Care Plan (MLTC for short) like Fidelis, Nascentia, Kalos Health, I-Circle, or Total Senior Care the same process applies. When you enter these programs, a nurse case manager will evaluate you and determine what services you need. These nurse case manager are employed by the MLTC company.

They do not work for the local county Medicaid office. Even so, they are subject to review by NYS Office of Temporary and Disability Assistance if you do not agree with the amount of services they are providing or if the services are reduced after a review. It is important to note that there are time limits to request a fair hearing. Many MLTCs only allow 60 days to request a fair hearing so it is best to make the request as soon as possible.

In addition to the fair hearing process, if you are not happy with the services you are getting through an MLTC plan, you can contact the long-term Medicaid ombudsman at ICAN (Independent Consumer Advocacy Network.) Just like ombudsman for people in Nursing Homes, ICAN was set up to help people understand their benefits and advocate for people getting long-term care services or behavioral health services at home or in the community. If you have questions about your Medicaid long-term care services and need help advocating for care, you can call ICAN at 1-844-614-8800 or visit their website https://icannys.org to send a message or electronically chat with an Ombudsman.

For more information on the fair hearing process visit Chautauqua County Health and Human Services website at https://chqgov.com/humansocial-services/fair-hearing-division or Legal Assistance of WNY at https://www.lawny.org/node/40/fair-hearings or contact or NY Connects Helpline at 716-753-4582.

Mary Ann Spanos is director for the Chautauqua County Office for the Aging.


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