A fair hearing is a review by the state of a decision made about your Medicaid: a denial, a termination, a reduction in home care hours, a spend-down amount, or a decision that never arrived. It is separate from an insurance company’s internal appeal, though for a managed care denial the plan appeal usually comes first.

In New York: it is run by the Office of Temporary and Disability Assistance, and there are two deadlines that do different things. You have 60 days from the notice date to request a hearing. Keeping your current benefits running while you wait is a second, earlier deadline: the request has to come before the effective date printed on the notice, or within 10 days of the notice being mailed — whichever of the two is later. And you must ask for aid continuing in those words. It is not automatic and it is not implied.

For someone whose home care hours are being cut, that distinction is the difference between care continuing on Monday and care stopping on Monday, because the hearing itself may take weeks to schedule.

Request by phone at 800-342-3334, online, or in writing following the instructions on the notice. It is free, no lawyer is required, and free legal services in New York City handle these hearings.

What actually decides one. A fair hearing is not a trial and not a formality: an officer checks whether the decision followed the rules on the facts of your case. The agency has to say what it relied on and produce the evidence it used, and you may see your file beforehand. These cases turn on timelines more than arguments, so the dated record of what you sent and when tends to matter more than how well you argue. Interpreters are available for both the call and the hearing.

Also called: aid continuing, state hearing, Medicaid appeal. Full guide: Medicaid fair hearings in New York.

More in Glossary of health coverage and billing terms

  • Federally qualified health center — A clinic required to charge by household income rather than by service, which is why it is the cheapest real option for most uninsured New Yorkers.
  • Managed care — A plan that pays a private insurer a fixed amount per member to run your benefits, which is why a network and prior authorization exist at all.
  • Cost-sharing reduction — A discount on the deductible and copays that only attaches to silver marketplace plans, and is invisible when you compare premiums.
  • Prior authorization — Prior authorization is a plan's approval before it pays for care. Who asks for it, what a denial says, where the deadlines are, and New York's appeal route.
  • Spend-down (excess income) — The monthly amount of medical expense you must incur before Medicaid covers the rest of the month, when your income is over the limit.

This page explains how the system works. It is not medical advice. More.