Medicaid appeals in Utah: hearing deadline and keeping benefits

Medicaid (Utah Medicaid) denials in Utah

Medicaid agency

Utah Department of Health and Human Services (DHHS), Division of Integrated Healthcare; eligibility decided by the Department of Workforce Services (DWS)

Who holds the hearing

DHHS Office of Administrative Hearings (services, managed care and disability decisions); DWS Division of Adjudication, Fair Hearings (Medicaid and CHIP eligibility)

Deadline for service decisions

30 days

The date the Medicaid agency sent its denial notice (decisions about services by the Medicaid agency). For Medicaid or CHIP eligibility decisions the deadline is 90 days from the date on the notice.

Deadline for eligibility decisions

90 days

The date on the eligibility notice you disagree with (if the 90th day is not a business day, the next business day)

How to ask for a hearing

• Form: Services or managed care: Form to Request a State Fair Hearing (English or Spanish), with a copy of the denial notice or the plan's appeal decision
• Online: Email the form to utmedicaidhearings@utah.gov (DHHS Office of Administrative Hearings)
• Fax: DHHS Office of Administrative Hearings, 801-536-0143
• Mail: Office of Administrative Hearings, Division of Integrated Healthcare, PO Box 143105, Salt Lake City, UT 84114-3105
• Phone: Eligibility: Department of Workforce Services Fair Hearings, toll-free 877-837-3247; you can ask orally, in writing or by email to DWS or DHHS
• Mail: Eligibility: Hearing Rights and Request for Hearing form to Department of Workforce Services - Fair Hearings, PO Box 143245, Salt Lake City, UT 84114-3245 (fax 877-824-6534, email fairhearings@utah.gov), or any Workforce Services Employment Center

medicaid.utah.gov · 801-538-6576

Mail address

Office of Administrative Hearings, Division of Integrated Healthcare, PO Box 143105, Salt Lake City, UT 84114-3105

What to include

Your name, phone and address, the member's name and Medicaid ID number, the reason for the hearing request, and your signature, plus a copy of the Medicaid agency's denial notice or the plan's appeal decision (without it the request cannot proceed). Say whether you want services continued and whether an attorney represents you.

Keeping your benefits during the appeal

Services: send the hearing form and a signed request to continue services within 10 calendar days of the date the Medicaid agency's notice was sent (or after the plan sent its appeal decision). Eligibility: medical benefits continue if you ask for a hearing before the effective date of the action or within 10 calendar days of receiving the notice, whichever is longer; the notice is treated as received 5 days after its date. If the hearing upholds the decision, you may have to repay the benefits.

Faster (expedited) hearing

If waiting could endanger the member's life, health or ability to attain, maintain or regain maximum function, call Administrative Hearings at 801-538-6576 to request an expedited hearing.

Law: Utah Admin. Code R410

Medicaid health plan (managed care) in Utah

Appeal to the plan first

If your Medicaid health, mental health or dental plan (Accountable Care Organization or managed care entity) made the decision, you must finish the plan's appeal first. Then send the Form to Request a State Fair Hearing to the DHHS Office of Administrative Hearings no later than 120 calendar days from the date of the plan's appeal decision, with a copy of that decision. To keep services during the hearing, send the form and a signed request within 10 calendar days after the plan sent its appeal decision.

Then a state hearing

120 days

The date of the plan's notice of its appeal decision

Law: 42 CFR 438.402, 438.408, 438.420

Write my appeal: free letters

Letter: Medicaid fair hearing request