Understanding Medicaid Fair Hearings in Florida

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Learn about preparing for your Medicaid fair hearing in Florida before the Office of Fair Hearings or Office of Appeal Hearings. Explore the role of Disability Rights Florida in advocating for the rights of individuals with disabilities and discover key information about the process, contact details, and resources available for assistance.

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Advocacy 101 Preparing for Your Medicaid Fair Hearing Before the Office of Fair Hearings or Office of Appeal Hearings Rachel Siegel-McLaughlin, Senior Staff Attorney Jatinique Randle, Staff Attorney June 08,2019

Disability Rights Florida Funding, responsibility, and authority under nine federal programs to protect the rights of Floridians with disabilities. A not-for-profit corporation since 1987. Offices in Tallahassee, Tampa, Gainesville and Hollywood. Satellite offices in several other communities.

Our Mission To advance the quality of life, dignity, equality, self determination, and freedom of choice of persons with disabilities through collaboration, education, advocacy, as well as legal and legislative strategies.

Agenda Introduction to Advocacy 101 What is the Office of Fair Hearings? What is the Office of Appeal Hearings? Notices and Requesting a Fair Hearing Preparing for Your Hearing Questions

Advocacy 101 Disability Rights Florida s Advocacy 101 is a manual designed to assist individual in preparing for a Medicaid case before: Florida Division of Administrative Hearings (DOAH) The Florida Office of Fair Hearings (OFH) The Florida Office of Appeal Hearings (OAH) Today s Presentation will focus on OFH and OAH Available Online at: http://www.disabilityrightsflorida.org/resources/disability_topics

The Office of Fair Hearings https://flmedicaidmanagedcare.com/home/medicaidfairhearing The Office of Fair Hearings (OFH) is part of the Agency for Health Care Administration. OFH employs hearing officers who conduct hearings in cases affecting fee-for-service and managed care recipients.

Office of Fair Hearings Contact Information OFH s contact information for Requesting a Medicaid Fair Hearing from AHCA is: Agency for Healthcare Administration Medicaid Hearing Unit P.O. Box 60127 Ft. Meyers, FL 33906 Telephone: (877) 254-1055 Fax: (239) 338-2642 Email: MedicaidHearingUnit@ahca.myflorida.com OFH s contact information for Obtaining Information from AHCA Regarding a Medicaid Fair Hearing Request is: Agency for Healthcare Administration Office of Fair Hearings 2727 Mahan Drive, MS#11 Tallahassee, FL 32308 Telephone: (850) 412-3649 Fax: (850) 487-1423 Email: OfficeofFairHearings@ahca.myflorida.com

The Office of Appeal Hearings https://www.myflfamilies.com/about-us/office-inspector-general/appeal- hearings/ The Office of Appeal Hearings (OAH) is part of the Florida Department of Children and Families Office of Inspector General. OAH employs full-time hearing officers who conduct hearings in cases where a state agency, such as the Agency for Persons with Disabilities (APD) or the Department of Children and Families (DCF), makes a decision which unfavorably affects a person s rights or benefits.

Office of Appeal Hearings Contact Information Contact information for the Office of Appeal Hearings: Department of Children and Families, Office of Appeal Hearings 1317 Winewood Blvd, Bldg. 5, Room 255 Tallahassee, Florida 32399 Telephone: (850) 488-1429 Fax: (850) 487-0662 Email: appeal.hearings@myflfamilies.com

Notices AHCA, APD, Managed Care Companies, and others must send you a written notice whenever they deny, reduce, or terminate your request for supports or services Verbal notice is not enough, do not accept verbal or other informal notice If you do not receive written notice, request it as soon as possible Look for these three things: 1. What is being denied or reduced? 2. What is the justification for the denial/reduction? 3. What are your appeal rights and instructions? Formats change, but content does not 10

Requesting an Appeal Follow the instructions in the Notice The deadline for requesting an appeal varies depending on the Agency, but it should be clearly stated on the Notice you receive Be sure to make it clear if you wish to continue to receive services pending the outcome of your appeal Make a written request for the appeal if possible, and save a dated copy of this request 11

Words to Know Petitioner: The person requesting an appeal, the person who s services are being reduced or denied Respondent: The Agency or organization that has reduced or denied petitioner s services Exhibit: A piece or set of evidence in a hearing, usually a document Hearing Officer: The presiding officer or judge at your hearing Burden of Proof: The responsibility of a specific party to use the evidence to prove to the court what the party believes the outcome should be. Must be proven by the preponderance of the evidence or more likely than not. 12

5 Steps of Preparation You should get a letter from OFH or OAH stating when and where the hearing will be held 5 steps: 1. Research the laws and rules that affect your care many can be found online, including some links provided in the Advocacy 101 manual 2. Write your arguments 3. Gather evidence and witnesses to support those arguments 4. Prepare your testimony 5. Request information from the Agency through the Discovery process If you need more time to prepare, you can request a continuance from the hearing officer, submit your request in writing. 13

The Hearing Itself The hearing will be telephonic for OFH The hearing can be telephonic or in-person (at your request) for OAH The hearing officer, the Petitioner s party, Agency area staff and potentially an Agency attorney will be present Try to approach the hearing and your arguments from a logical and rational, not emotional, standpoint Let the Hearing Officer guide the proceedings, but do not be afraid to speak up 14

How to Prove Your Case You have to know the law, you cannot rely only on a sense of fairness or unproven need You need to know who has the burden of proof You should assert facts that you can prove Avoid generic or summary language Respond directly to the agency s arguments Listen carefully and take notes 15

What Happens Next? There will not be an immediate response from the Hearing Officer After a few weeks you will receive a written decision from the Hearing Officer, called a final order Read the final order carefully to determine what has been affirmed and/or what has been denied. 16

Appeals An appeal must be filed within 30 days of the Final Order You may file in either the 1st District Court of Appeals or the District of your residency Appeals must be based on legal issues, not factual issues and ONLY on issues raised during the hearing Clerk of Courts are a valuable resource 17

Requesting Accommodations Contact OAH or OFH by phone or email to request an accommodation for your hearing. You should make this request as early as possible and at least 7 days prior to your hearing date. 18

Jay has received a notice in the mail about a termination of his services. What should he look for in the notice?

Jay has received a Notice of Adverse Benefit Determination in the mail from his Medicaid Managed Care Company regarding a reduction of his services. What are his next steps in requesting to appeal the action taken in the notice?