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State Hearings

Administrative Appeals

State Hearings

For what reasons can I ask for a state hearing?

You can ask for a state hearing when a Medicaid agency has done (or proposed to do) any of the following:

You can also ask for a state hearing if you believe that the level of your benefits or services is not correct.

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Will I get notice of my right to a hearing?

When the agency reduces, suspends, or terminates your benefits or services, it must mail you written notice at least 15 calendar days beforehand.

When the agency denies your request for prior authorization, it must mail you written notice promptly.

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What will the notice say?

The notice must have the following information:

  • a clear & understandable statement of the proposed action and the reasons for it;
  • an explanation of your right to and how to get a county conference and a state hearing;
  • an explanation of how you can get a “stay put” on your services by timely asking for a hearing;
  • the applicable regulations;
  • a telephone number to call about free legal services.

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How do I ask for a hearing?

You can call or write your local agency (county department of job and family services) or the Ohio Department of Job and Family Services’ Bureau of State Hearings. 

You must clearly state that you want to appeal a decision or want to present your case to a higher authority. If you receive prior notice, you can fill out that form and mail it to the Bureau of State Hearings.

You can ask for a state hearing from the Bureau of State Hearings in several ways:

Mail: P.O. Box 182825, Columbus, Ohio 43218-2825.
Fax: (614) 728-9574
Emailbsh@jfs.ohio.gov, and in the subject line put "State Hearing Request"
Phone: 1-866-635-3748, and choose option number one from the automated voice menu.
Onlinesecure.jfs.ohio.gov/ols/RequestHearing

Unless you did not receive notice of hearing rights, the Bureau or local agency must receive your request within 90 calendar days (beginning on the day after the notice was mailed). If the last day falls on a Saturday or Sunday, or a State or Federal legal holiday, the time period extends to include next workday.

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Can someone ask for a hearing for me?

Yes, but this request must be in writing (only you can make a request by telephone).

If someone asks for a hearing for you, the request must include a “written authorization”—a written statement, signed by you, telling the Bureau of State Hearings that the other person is your representative. There are two exceptions to this:

  • if you are a minor, your parent can ask for a hearing for you without written authorization;
  • if you have a guardian, your guardian can ask for a hearing for you without written authorization.

Please see [PDF] Medicaid State Hearing request form for a blank template that you can use.

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Can the Bureau of State Hearings deny my request for a hearing?

Yes.  A hearing request can be denied for any of the following reasons:

  • you did not ask for a hearing in time (unless you did not receive proper notice);
  • the request was not made by you or your authorized representative;
  • the authorized representative did not submit proper authorization;
  • the issue is not appealable;
  • the reason for your request is due to a change in state or federal law or local agency policy that requires automatic changes in benefits for classes of recipients (unless the reason for the request is a misapplication of the change to your individual circumstance);
  • the issue has been previously decided through the state hearing process.

If your request is denied, you and/or your authorized representative must be provided written notice (“State Hearing Dismissal Notice”). You have the right to appeal this decision.

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Can I keep my benefits or services while I wait for the hearing (can I get a “stay put” on my services)?

It depends on when the Bureau of State Hearings receives your request. 

If you disagree with a notice that your benefits or services are going to be reduced, suspended, or terminated, you should request a hearing immediately—within 15 calendar days. If the Bureaureceives your hearing request within 15 calendar days of the mailing date on your notice, then you can keep your benefits until your hearing decision is issued. This is called a “stay put.”

If the agency reduces, suspends, or terminates your benefits without mailing you prior notice, and the Bureau receives your hearing request within 15 calendar days from notice of the adverse action, your benefits must be put back to the previous level.

If you send in your request late, you still may be able to get a stay put on your services.  If the Bureau receives your request within 10 calendar days after the date of the adverse action, & good cause is shown for the delay, your benefits must be put back to the previous level. “Good cause” means:

  • death in the immediate family
  • sudden illness or injury of you or a member of your immediate family, or
  • other circumstances or good reasons that reasonably prevented you from asking for a hearing on time.

If you withdraw or abandon your appeal, or the hearing officer states that the issue is not appealable, you will no longer receive a stay put.

If you receive a stay put and you lose your hearing, you may have to pay back any benefits that you were not eligible to receive.

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What is a county conference?

A county conference is a conversation between you and the agency that is less formal than a state hearing. The idea is that if you informally discuss and/or resolve disagreements with the agency, it could avoid unnecessary state hearings. You are not required to have a county conference in order to request a state hearing. And, if your disagreement is not resolved through a county conference, you still have the right to request a state hearing.

For a Medicaid managed care plan, the plan’s appeal or grievance process substitutes for the county conference requirement.

If you request a county conference, the agency convenes a conference presided over by the agency’s director or a designee. Both you and the agency may bring whoever you reasonably want to be at the conference.

If the presiding person decides that the agency acted incorrectly, that person will retract the notice of adverse action or arrange to make that determination as quickly as possible. This outcome is recorded in writing in the case record.

A state hearing must still be held after a county conference unless (1) a resolution is reached at the county conference and (2) you withdraw your hearing request in writing. The withdrawal must be signed and dated by both you and the agency representative, clearly set forth the resolution upon which the withdrawal is based, and be forwarded to the assigned hearings section within two business days.  

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When will my hearing be held?

The Bureau of State Hearings will mail you a scheduling notice giving the time, date, and place of the hearing. This notice will be mailed at least 10 calendar days before the hearing.

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Can I postpone my hearing if I cannot come to the scheduled hearing or if I need more time to prepare?

Yes, if you have good cause for asking for the postponement. The hearing authority will determine whether good cause exists.  You may be asked give reasons for asking to postpone the hearing.

The hearing authority may deny repeated requests for postponement. If your request is denied, then you and/or your authorized representative must attend the hearing. If you do not attend the hearing, your hearing may be dismissed.

If you have a stay put, your benefits and services should continue even if you ask to postpone the hearing. (See the question “Can I keep my benefits or services while I wait for the hearing (can I get a “stay put” on my services)?” above for an explanation of a stay put.)

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Where will my hearing be held?

Hearings are usually held at the local county department of job and family services. If you are not able to go there, you can ask for the hearing to be held at some other place convenient to you and to the other people involved. You can state this on your hearing request, or you can contact the Bureau of State Hearings.

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Can I ask for a telephone hearing?

Yes.  If you cannot attend the hearing at the scheduled location, you can contact the Bureau of State Hearings and choose to participate by telephone. If you participate by telephone, the hearing officer assigned to your appeal will call you on the day and scheduled time for your hearing at the telephone number you provide.

The Bureau may also schedule your hearing as a telephone hearing without your request. Your scheduling notice will state this. You have the right to request a face-to-face hearing instead, but you must request this at least three days before the scheduled hearing. A face-to-face hearing happens by video conference or in person.

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Who will be at my hearing?

Attendance at the hearing will include the following people:

  • Hearing officer
  • Agency representative;
  • You and/or your authorized representative

If you are not going to be at the hearing, the person attending for you must bring a written statement from you saying he or she is your authorized representative

Attendance at the hearing may also include the following people:

  • Witnesses that you and/or the agency invite. If space is limited, witnesses may be called into the hearing room one at a time.
  • Legal representation that you and/or the agency bring. You can bring an attorney to the hearing, and the agency can bring an attorney to the hearing.
  • Other persons only if you agree and if their attendance does not interfere with the orderly conduct of the hearing.

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Will I have a time to review documents at the hearing?

Yes. You must be given a reasonable time before the hearing, as well as during the hearing, to examine your case file and all records or documents that will be used by the local agency at the hearing.

If the local agency does not let you look at this information, this may give you reason to postpone or continue your hearing to a later date. 

The local agency does not have to show you confidential records, such as names of people who have given information against you, records of criminal proceedings, and certain medical records.  If you have not had a chance to review these records, they cannot be presented at the hearing or be used by the hearing officer in reaching a decision.

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What is an appeal summary?

An appeal summary is a document the agency prepares that is meant to provide a summary of the reasons for its action, including relevant facts and documents.

The agency must give the appeal summary to the Bureau at least 3 business days before the hearing. The agency must also make this appeal summary available to you and/or your authorized representative. If the agency does not give you its appeal summary and this seriously harms your argument, this may be good cause to postpone or continue the hearing to a later date.

While the agency must provide an appeal summary (and make this appeal summary available to you), you are not required to submit an appeal summary. You may simply testify at the hearing to the facts and present your argument. However, you can write an appeal summary and send it to the bureau and/or hearing officer before the hearing.

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Can I submit documents before the hearing or at the hearing?

Yes. In fact, you must submit your documents to the appropriate hearings office before the hearing for the documents to go into the official hearing record. You can also submit documents at the hearing, though the agency must have time to review them.  You can ask the local agency to help you copy and send your documents.

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Can I ask the hearing authority to subpoena documents or witnesses?

Yes. A subpoena is a document that legally requires someone to show up to your hearing, or legally requires someone to provide documents to your hearing. If there are witnesses and/or documents that are essential to your case and they are not otherwise available, you can request a subpoena. You must request the subpoena at least five calendar days before the hearing and provide the name and address of the person or document you want subpoenaed. 

The hearing authority will decide whether to issue subpoenas and whether subpoenaed individuals must participate in person or by telephone.

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What if I do not attend my hearing?

If you do not come to your hearing (you “abandon” your hearing), the Bureau of State Hearings will send you a dismissal notice.  However, if you had a good reason for missing your hearing, and you still want to continue with your hearing request, you must contact the Bureau within 10 days and explain why you did not come to the hearing (demonstrate “good cause” for not coming). “Good cause” is defined as:

  • death in the immediate family
  • sudden illness or injury of the individual or a member of the individual’s immediate family, or
  • other circumstances that reasonably prevented attendance at the hearing.

The hearing authority will decide whether you had good cause.

If you do not call within 10 days and show good cause, the hearing will be dismissed and you will lose the hearing. The Medicaid agency can then go ahead with the action it was planning to take.

Finally, if you disagree with the dismissal, the dismissal notice will tell you how to ask for an administrative appeal.

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Will my hearing be recorded?

Yes. There will be a tape recorder at your hearing that records everything that is said.  The Bureau will keep this recording for 30 calendar days after the hearing decision is issued. If you request an administrative appeal, the recording will be kept for another 7 months or until after all administrative appeal proceedings have been completed.

After the hearing decision is issued, you can get a free copy of the recording by contacting the Bureau of State Hearings.

You may also record the hearing at your own expense, so long as it does not seriously interfere with the orderly conduct of the hearing.

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Can I get an interpreter for my hearing?

Yes. If you or your authorized representative has limited proficiency in English, or if you communicate using sign language, the local agency must provide an interpreter at your request.

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Who has the burden of persuasion at the hearing?

The agency. It is the responsibility of the agency to show, by a preponderance of the evidence, that its action or inaction was in accordance with Ohio law.

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What will happen at the hearing?

The hearing will be conducted informally. The hearing officer begins by starting the recording equipment and providing introductory information.

After opening remarks, the hearing officer will state the issue to be heard, as it appears on the hearing request. The issue must always be whether the agency’s action or inaction was in accordance with applicable regulations. You or the agency may request to amend the issue as stated or add any issues, though additional issues will only be added if you both agree, both are prepared to address the additional issue, and if there is adequate time to do so.

The hearing officer will record the name and role of each person in attendance and administer an oath or affirmation to all who are testifying at the hearing.

The hearing officer will then ask people to state their arguments and share their evidence. Normally, the agency will make their arguments first. You and the hearing officer will have the opportunity to ask questions, refute any testimony or evidence, and ask questions and refute any of their witnesses. Then, you will have the opportunity to present your arguments and evidence in your own way.  The agency and hearing officer may ask you questions and question or refute your witnesses.

Both parties will then be allowed a brief closing statement.

If, during the hearing, not all relevant testimony and evidence has been presented, the hearing officer may order a continuance (meaning the hearing will continue on at a later date) or leave the record open (meaning either side can submit additional documents for a short period of time after the hearing.) Any documents that are not available for review during the hearing may not be submitted unless the other party is provided the opportunity for rebuttal.

The hearing officer then closes the hearing by informing the parties when they can expect a written decision, adjourning the hearing, and turning off recording equipment.

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What happens after my hearing? When should I receive my hearing decision?

After your hearing, the hearing officer will review the testimony and other evidence presented at the hearing and issue a hearing decision.

You will receive the written decision in the mail, issued by the hearing authority.  Hearing decisions typically must be issued within 70 calendar days from date of the hearing request.

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What will the hearing decision say?

The decision must include the following information:

  • The issue or issues to be decided (including the action or lack of action that you disagreed with);
  • Procedural matters (for example, whether the hearing was postponed, when the agency’s appeal summary was submitted, whether there was a “stay put” on services, etc.);
  • Findings of fact (a clear & orderly chronological discussion of facts & events);
  • Conclusions of policy (a description of the state’s laws and rules. It is generally based solely on the Ohio Administrative Code or local agency policy);
  • Recommendations (If the hearing officer agrees with you, s/he will sustain your appeal and find that the agency acted incorrectly; if the hearing officer disagrees with you, s/he will overrule your appeal and find that the agency’s action was correct; or s/he will dismiss your appeal if you withdraw your hearing request in writing).

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Can my hearing decision be translated for me?

Yes. The bureau will provide a translation in accordance with the ODJFS Language Access Policy.

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When the decision orders the agency to take action, is the agency responsible for complying?

Yes. If the decision is in your favor, the agency must comply within 15 calendar days from the date the decision is issued, but in no event later than 90 calendar days of your hearing request.

If the decision is not in your favor, the agency must implement the decision promptly, if still appropriate.

The Bureau of State Hearings is responsible for monitoring timely compliance with decisions. If the agency fails to comply with the decision, you can contact the Bureau’s compliance office at 866-635-3748 or state_hearings_compliance@jfs.ohio.gov.

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If I disagree with the hearing decision (or a decision denying or dismissing my hearing request), can I appeal?

Yes. This is called an administrative appeal. The hearing decision must provide notice of your right to ask for an administrative appeal, and give you instructions on how to do it.

The Bureau of State Hearings must receive your administrative appeal request within 15 calendar days from the date the decision was issued.

If the request is not made within 15 calendar days, your appeal may be dismissed.

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Administrative Appeals

What is an administrative appeal?

An administrative appeal is essentially a letter that clearly states that you want to appeal and explains the reasons why you disagree with the hearing decision.  It must be in writing and it must be signed. There is no required format for the administrative appeal request.

If you want someone else to request an administrative appeal for you, you must include a “written authorization”—a written statement, signed by you, telling the Bureau that the other person is your authorized representative. There are three exceptions to this: (1) if you are a minor, your parent can ask for an administrative appeal for you without written authorization; (2) if you have a guardian, your guardian can ask for an administrative appeal for you without written authorization; (3) if the person asking for the administrative appeal is the same person who submitted authorization at your state hearing, he or she does not have to submit another authorization statement.

If the request for appeal is not made by you or your authorized representative, the appeal may be dismissed.

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Where do I send my request for an administrative appeal?

You should send your request for an administrative appeal (along with a copy of the state hearing decision) to the Ohio Department of Job and Family Services/Bureau of State Hearings:

Mail: P.O. Box 182825, Columbus, Ohio 43218-2825.
Fax: (614) 728-9574
Email: bsh@jfs.ohio.gov

You may also request an administrative appeal by completing the online form at secure.jfs.ohio.gov/ols/RequestAppeal.

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If I request an administrative appeal, will I have another hearing?

No. The administrative appeal request is the only documentation you submit. For an administrative appeal, the Bureau of State Hearings doesn’t hold another hearing or meet with you in person. Instead, they read arguments in your administrative appeal request, and have a different person than your hearing officer take a second look at the hearing you already had. Since you don’t meet in person again, you need to be sure to include your explanations, arguments, or documentation with your administrative appeal request.

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Will my services continue through the administrative appeal (will I keep my “stay put”)?

It depends. Requesting an administrative appeal does not automatically prevent your hearing decision or dismissal from being carried out. However, you can ask the Bureau of State Hearings to delay implementation of the hearing decision; in other words, you can ask the Bureau of State Hearings to continue your Medicaid benefits and services until the Administrative Appeal is decided (get a “stay put”).  

If the Bureau of State Hearings thinks your administrative appeal has a good chance of winning, and if the appeal will not be processed in time to prevent a loss of your services, the Bureau may issue a stay put, and let you keep your Medicaid benefits until the Administrative Appeal is decided. If you want the stay put, you should ask for it in your administrative appeal request.

An order to delay implementation of the hearing decision (to get a “stay put” on your services) does not mean you have won your appeal, but only means your Medicaid benefits or services will continue until an official decision on your appeal is made.

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What happens after I submit my administrative appeal request?

Once the request is received, an administrative appeal officer will review your request, the hearing decision, and the hearing record and/or recording, if appropriate. The administrative appeal officer will be a different person than your hearing officer, and it will be an attorney.

The hearing decision will be reviewed for one or more of the following reasons:

  • The decision is contrary to the weight of the evidence presented.
  • A prejudicial error was committed in the course of the proceedings.
  • The decision relies on an incorrect application of law or rule.

The administrative appeal officer will then issue a decision. The decision must be issued within 15 calendar days from the date of your request for the administrative appeal. 

The decision will sustain your appeal (or reverse the hearing decision) if it rules in your favor, or it will overrule your appeal (affirm the hearing decision) if it rules in the agency’s favor. The decision may also vacate the hearing decision and remand to the hearing officer if the record does not contain enough information to decide the appeal. In this case, sometimes a supplemental hearing is held. You will still have your appeal rights if the decision resulting from the supplemental hearing is not in your favor.

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Can the administrative appeal decision result in a determination that is worse than the hearing decision?

No. The Administrative Appeal Decision cannot result in determination more adverse to you than in the initial hearing decision.

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When the decision orders the agency to take action, is the agency responsible for complying?

Yes. If the decision is in your favor, the agency must comply within 15 calendar days from date the decision is issued, but in no event later than 90 calendar days of your hearing request.

If the decision is not in your favor, the agency must implement the decision promptly, if still appropriate.

The Bureau of State Hearings is responsible for monitoring timely compliance with decisions. If the agency fails to comply with the decision, you can contact the Bureau’s compliance office at 866-635-3748 or state_hearings_compliance@jfs.ohio.gov.

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If I disagree with the administrative appeal decision, can I appeal?

Yes. You have the right to further appeal to the court of common pleas in the county in which you reside. 

Appealing to the court of common pleas will cost money. If you can’t afford the court costs, you may apply to the court for designation as an indigent (a person of low income).  If the court grants this application, you would not be required to furnish the costs of the appeal.

To begin the process, you must mail a notice of appeal to ODJFS:

Ohio Department of Job and Family Services
Office of Legal Services
30 East Broad Street, 31st Floor
Columbus, Ohio 43215-3414.

You must also file notice of appeal with the local county court of common pleas. The notice that is filed may be either the original notice or a copy of the original notice.

The notice of appeal must state the following:

  • your name and the name of  the Ohio Department of Job and Family Services (ODJFS);
  • the docket number on your administrative appeal decision;
  • the date of the administrative appeal decision that you are appealing;
  • a copy of the administrative appeal decision/order being appealed;
  • include the following statement/argument: “The agency’s order is not supported by reliable, probative, and substantial evidence and is not in accordance with law.”; and
  • state the reasons you think the order was incorrect.

You must mail and file the notice of appeal no later than 30 calendar days after the date the administrative appeal decision was sent to you. However, the court may extend the time for mailing and filing notice if you can provide a good reason/good cause why it was late (but it cannot be more than 6 months late).

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Where can I find more information?

Chapter 5101:6 of the Ohio Administrative Code governs the Medicaid appeals process. 

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