Medicaid Appeals Part 2: The Hearing Process

"I filed a hearing. Now what happens?"

You disagreed with DHHS and filed a hearing.  Here is a brief explanation of what happens next.  

Call Legal Services to see if you qualify for legal services to represent you. For Washtenaw County, contact Legal Services of South Central Michigan (LSSCM). LSSCM provides provides general civil legal services to low-income and senior citizens of Barry, Branch, Calhoun, Clinton, Eaton, Hillsdale, Ingham, Jackson, Lenawee, Livingston, Monroe, Shiawassee, and Washtenaw Counties.  To find help in other Michigan counties or elsewhere, Legal Services has a searchable map.

Then you start the process with the DHHS office. 

The Hearing Process

Phone Call

You may receive a phone call from your caseworker or supervisor. (You also may not receive a phone call.)  The DHHS representative may explain why you were denied and/or try to talk you out of filing a hearing.  They may agree that there is an error and say they will fix the problem.  Sometimes, they say they will fix the decision, you just need to "withdraw the hearing." 

Do not withdraw the hearing unless you agree with DHHS's decision after an explanation from the caseworker or supervisor.  If they agree there is a problem and say they will fix the problem, wait until the DHHS caseworker provides proof they have fixed the problem to withdraw the hearing. When you withdraw a hearing you are agreeing that DHHS has made the right decision and you cannot appeal that decision again. 

Pre-Hearing Conference

DHHS will schedule a Pre-Hearing Conference.  This meeting is a chance for you to explain the reason for your request for hearing, present any documents and see if the dispute can be resolved before the hearing. Typically these meetings are with your caseworker and their supervisor.  If you are correct and DHHS says they are going to correct the decision, do not withdraw the hearing until you have received a new determination letter or case action notice.  You should also confirm the changes have been made.  You may receive a summary in the mail but until you withdraw the hearing or the hearing takes place, your full hearing is still being scheduled.

You do not have to attend a pre-hearing conference, and if you don't attend--or if you attend but no agreement is reached--the appeal continues to a full hearing.

The HEaring

The Hearing is a formal meeting with an Administrative Law Judge (ALJ). You can request that the hearing be in person--otherwise the ALJ may call in. Typically the caseworker and supervisor are in attendance. You are allowed to bring legal representation or a case advocate from a nonprofit, and in some cases Legal Services will be able to represent you. You can also request accommodations, such as a second language or sign language interpreter. Bring documents to support your case. The DHHS staff present their position, and then you will have a chance to present your position. The judge may ask you or DHHS staff additional questions. The ALJ will issue a decision.

The Decision

The ALJ will issue a decision.  You will receive a copy of the decision in the mail.  If your benefits were denied, you can reapply.  If your benefits were reinstated, DHHS should comply with the judge's order in a timely manner. 



Tips for Hearings from Michigan Legal Help

  • Bring any documents to the hearing you think might be needed to verify your income.
  • If it is difficult or impossible for you to provide certain documents, be prepared to tell the Administrative Law Judge what you have done to try to get the documents that are needed.
  • If you believe you have already provided all of the documents DHHS asked you for, the hearing is your opportunity to tell the ALJ what documents you provided, when you provided them, and how you delivered them to DHHS. Make sure you bring this information with you, along with anything you have that may show you already provided the documents.
  • You are allowed to have a lawyer, friend or other person represent you at the hearing.
  • Be prepared to spend most of the morning or afternoon at the hearing.
  • Arrive at the hearing location 10 or 15 minutes before your hearing is scheduled. Dress neatly, like you would for a job interview.
  • When you get there check in with the desk clerk.
  • You will be sworn in. Answer the ALJ’s questions clearly. Ask questions if you don't understand what is being said.
  • A DHHS employee will also have a chance to speak. When the DHHS worker talks, take notes. Don’t try to interrupt. You will have another chance to speak.
  • The ALJ will wait until everyone has had a turn to speak before making a decision. Or, the ALJ may not make a decision at the hearing. You may have to wait to get the ALJ’s decision by mail. Ask the ALJ questions if you don't understand what the decision is or when you will find out. The hearing is your opportunity to tell the ALJ your side of the story and explain why your benefits shouldn’t be terminated or reduced. 


Read Part 1, Medicaid Appeals: How to File a Hearing.



Legal Services of South Central Michigan

Find Legal Aid anywhere in the United States from Legal Services Corp.

I Need to Appeal DHHS's Denial or Termination of My Benefits self-help online tool from Michigan Legal Help.

Going to Court:  Extra Tips and Forms Toolkit from Michigan Legal Help

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Medicaid Appeals Part 1: Filing a Hearing

"I am eligible for Medicaid, but I was denied."

"I faxed my documents to my caseworker but my case was closed for failure to submit documents."  

"My Health Care Determination Letter says I make more money than I do and I was denied Medicaid."  

When you disagree with a Department of Health and Human Services decision, you have the right to file an appeal.  But how do you do that?  What happens?  Do you need a lawyer? 

In the interest of time and communication, it is always preferable to attempt to contact your caseworker and resolve the problem.  But sometimes that just doesn't happen.  Also, if you have already received a denial letter, generally your choices are to file a hearing request OR reapply.  If you decide to file a hearing, you need to fill out a hearing request form and turn it in as soon as possible. If you are not able to turn the hearing in at your local DHHS office,  you can fax the completed form to (517)346-9888.  

NOTE: You can request hearings for any programs that DHHS offers, not just Medicaid.

Reasons to File a Hearing Request

Income discrepancy

You may be denied for being over the income limits for your benefit program.  For many people, their income is not straightforward.  If you are self-employed or a seasonal worker, your income may vary from month to month or year to year. If you disagree with the income on your Determination Letter, you should file a hearing. 

Standard of Promptness

DHHS has a 45 day standard of promptness for processing applications.  If you have not received a Health Care Coverage Determination Letter within 45 days of your application, you should file a hearing.  


Your letter may state that you are eligible for a MA Deductible or MA Spend down.  This is a Medicaid program for people who are over income for Medicaid.  (Read more about Deductible and Spenddown here.)  A Medicaid deductible is not Minimum Essential Coverage and you will incur a tax penalty if it is your only coverage.  If you believe you or your children are eligible for full Medicaid, you should file a hearing.  

"You failed to return... documents."

You may get a letter that says you failed to return a document or requested verification.  If you have proof that you did turn in the documents by the due date listed on the letter, you should file a hearing.  It is always best to upload or fax documents to DHHS.  When you upload a document to your MiBridges account, it appears directly into your account.  When you fax a document, it is scanned and added to your account.  Always keep proof of any faxes sent to DHHS.  It proves you returned the required documents on time.  Mailing documents back to DHHS is not recommended.  You do not have proof that you mailed your documents back and frankly, mailed documents rarely make it into your account.  

Remember--when a caseworker requests a document by a certain date, you can request two 10 day extensions.  Again, it is best to have proof that you have requested an extension by either emailing your caseworker or faxing a request. (How to find a DHHS caseworker's email address or phone number.)

Immigration Issues

"I am eligible for full Medicaid but I have Medicaid Emergency Services Only."  


"I am only eligible for Medicaid Emergency Services Only but have full Medicaid."

If you are a US Citizen and you are income eligible, you should receive full Medicaid.  If you are not a US Citizen and you are not a qualified immigrant, you are eligible for Medicaid Emergency Services Only (ESO).  It is tricky to answer the questions on the Medicaid application and sometimes caseworkers make mistakes about who is eligible and who is not eligible for full Medicaid and Medicaid ESO.  [If you are pregnant, you can get Medicaid ESO and a special coverage called MOMS.]  If you are unsure about your eligibility or have any questions, please call the Washtenaw Health Plan at 734-544-3030 or check Immigrant Information. The Michigan Immigrant Rights Center is also a good resource.  


the Request For Hearing Form

Request for Hearing form

Request for Hearing form

The Hearing Request Form is located here.  You can download and print it. Fill out the request with all your information - Case Name, Case #, contact information and your caseworker's name.  State the reason you are filing the hearing. You don't need to give a lot of detail. 

"My family was denied Medicaid for being over income but we are eligible."

"I was denied for not returning requested documents on time but I faxed the documents on August 8, 2016 which was before the due date of August 10, 2016.  Attached is proof of my fax."

"My children are eligible for MIChild." 

"I applied 2 months ago and have not received any letters about my health care."

You can attach relevant documents to the hearing and explain the situation further if you want, but this is not required.  

Make sure you submit the Hearing Request before the deadline.  The deadline is listed on the last page of your Denial or Determination Letter.  If you want to meet the caseworker and supervisor in person, make sure to request an In-Person Hearing.  Write "In-Person Hearing Requested" on your form. 

That's it.  Fill it out and turn it in.  The next blog will explain the Hearing Process!  


Next:   Medicaid Appeals Part 2:  The Hearing Process


How to Find a DHHS Caseworker's Email Address and Phone Number

Hearing Request Form

Legal Services of South Central Michigan (LSSCM)

Michigan Immigrant Rights Center


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