State Fair Hearings

You or your authorized representative can ask for a State Fair Hearing if you do not agree with the appeal decision. You can also ask if is not resolved within 30 calendar days for a standard request or 72 hours for an expedited request. You must ask for a hearing within 90 calendar days of the date on your decision letter.

How do you ask for a State Fair Hearing?

Who can ask for a State Fair Hearing?

You or your authorized representative may ask for a State Fair Hearing. After you ask for this:

  • We will give the Adverse Benefits Determination and Notice of Appeal resolution letters within 2 business days to the DHS Office of Appeals and Hearings.
  • We will send an evidence packet to you and the State Fair Hearing officer within 10 business days.

Who can represent you at a State Fair Hearing?

You have the right to be represented by a lawyer if you choose.

How do you keep getting services during a State Fair Hearing?

If you get approved services that are now denied, you have the right to get them during the State Fair Hearing process. You must ask to keep getting the services within 10 calendar days from the date listed on your decision letter. If you keep getting the service, you may have to pay if:

  • You withdraw the hearing request.
  • You withdraw the request for continuation of services.
  • The decision is not in your favor.

What happens at a State Fair Hearing?

We will go over why we made our decision. You will then go over why you think we were wrong. The hearing officer will listen and decide who is right. Their decision will be based on the information given and whether we followed the rules.

  • If it is in your favor, we will provide the services as quickly as we can. It will be no more than 72 hours after the decision.
  • If it is not in your favor, we may ask you to pay for the services you got while the appeal and/or State Fair Hearing were going on.

Member Services: 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. – 5 p.m. CT