Understanding your right to appeal decisions made by the Office of Public Assistance

Fair Hearings are a process used to challenge or appeal a decision that the Office of Public Assistance has made that resulted in benefits being denied, reduced, or ended. Fair Hearings are sometimes called an appeal or administrative review. If you think that the Office of Public Assistance has made a decision that is incorrect, unfair, or against the rules, a fair hearing is the process you use to challenge the decision.

Fair hearings are used for many public benefits programs including Medicaid, Healthy Montana Kids, SNAP, TANF, and more.

Here are some reasons someone might request a Fair Hearing for Medicaid or Healthy Montana Kids:

• Medicaid is denied/closed and the applicant thinks they should qualify
  
• Medicaid coverage is closed for not providing requested documents and verification, but the applicant believes they submitted all required paperwork
  
• Medicaid coverage is delayed because it is taking longer than 45 days for the OPA to process a new Medicaid application (or a re-application if someone lost coverage). The timeline is 90 days for Medicaid applications requiring a disability determination.

If you think that the Office of Public Assistance has made a mistake on your Medicaid or Healthy Montana Kids case, here are some resources that provide more information on the Fair Hearing process, how to get started, and what to expect. 

• Montana Law Help has a page, Fair Hearings: How to Defend Your Rights (FAQ). It will walk you through the entire process from requesting a fair hearing to what to expect throughout. 

• The Montana Office of Administrative Hearings is the state office that administers Fair Hearings and Administrative Reviews. They also have a FAQ about the process.

• Check out the Montana Medicaid Policy Manual section on Fair Hearings.