Connecticut Department of Social Services Uniform Policy Manual: 1570.05 Fair Hearings - General Provisions

CONNECTICUT DEPARTMENT OF SOCIAL SERVICESPRIVATE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 02-13-01 Transmittal: UP-01-04 1570.05 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS General Provisions ______________________________________________________________________________ 1570.05 A. Purpose

The purpose of the Fair Hearing process is to allow the requester of the Fair Hearing to present his or her case to an impartial hearing officer if the requester claims that the Department has either acted erroneously or has failed to take a necessary action within a reasonable period of time.

B. Right to a Fair Hearing

Subject to the conditions described in this chapter, the requester has the right to a Fair Hearing if:

1. the Department denies the assistance unit's application for benefits; or

2. the Department does not take action on the assistance unit's application within the time limits specified in Section 1500; or

3. the requester feels that the Department has either failed to take a required action or has taken an erroneous action. Such actions include:

suspending, reducing, discontinuing, or terminating benefits; or

b. imposing conditions upon eligibility; or

c. issuing benefits in a manner other than directly to the assistance unit; or

d. taking any other action affecting the receipt of benefits, such as computing the amount of benefits.

C. Denial or Dismissal of Request for a Fair Hearing

The Department denies or dismisses a request for a Fair Hearing if:

the request for the Fair Hearing is not made within the time limits described in this section; or

2. the requester or his or her representative withdraws the request in writing; or

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 02-13-01 Transmittal: UP-01-04 1570.05 page 2 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS General Provisions ______________________________________________________________________________

1570.05 C. Denial or Dismissal of Request for a Fair Hearing (continued)

3. the requestor or his or her representative fails to appear at the scheduled hearing without good cause; or

4. the sole issue is one of state or federal law requiring automatic benefit adjustment for a class of recipients. In such cases, the requester has a right to a hearing only if the issue is that the Department has misapplied the law or that the Department has made an error in computation.

D. Who Can Request a Fair Hearing

1. Any member of the assistance unit, as well as the unit's authorized representative, or conservator of a unit member, has the right to request a Fair Hearing.

2. In the Medicaid program, the following persons have the right to request a Fair Hearing on behalf of a deceased unit member:

a. spouse;

b. child or parent;

c. executor, administrator or conservator;

d. any other person who, during the deceased's lifetime, assumed personal financial liability for the deceased's medical debts which would be covered under Medicaid.

3. Others who may be aggrieved by a Department action, and have a right to a Fair Hearing, are those persons from whom the Department is attempting to recover income or assets, as described in Section 7500.

4. In the Medicaid program, a community spouse, as well as the community spouse's authorized representative, or conservator of a community spouse, has the right to request a Fair Hearing regarding:

a. the assessment of spousal assets (Cross Reference 1507.05); and

b. the determination of the Community Spouse Disregard (CSD) (Cross Reference 4022.05); and

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 10-1-89 Transmittal: UP-89-46 1570.05 page 3 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS General Provisions ______________________________________________________________________________

1570.05 D. 4. Who Can Request a Fair Hearing (continued)

c. the determination of deemed assets (cross reference 4025.65); and

d. the determination of the Community Spouse Allowance (CSA) (Cross reference 5035.30); and

e. the determination of the Community Family Allowance (CFA) (cross reference 5035.35).

E. Party to a Hearing Requested by Another

1. The Fair Hearing official may grant status as a party to a hearing requested by another. To be granted this status, a person must meet the following conditions:

a. he or she is directly affected by the action taken by the Department;

b. he or she is a person who can request a hearing on his or her own behalf, as listed in D, above;

c. he or she submits a written request to the Department at least five days prior to the scheduled hearing;

d. he or she has sent a copy of the request to the person who originally requested the hearing and to any other person who is a party to the hearing;

e. the request states facts that demonstrate that the requestor's legal rights, duties or privileges are directly affected by the Department's action.

2. The Fair Hearing official may waive the five day deadline for requesting party status if there is good cause.

F. Intervenor

1. The Fair Hearing official may grant status as an intervenor. To be granted this status, a person must meet the following conditions:

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 10-1-89 Transmittal: UP-89-46 1570.05 page 4 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS General Provisions ______________________________________________________________________________

1570.05 F. 1. Intervenor (continued)

a. he or she must submit a written request to the Department at least five days prior to the scheduled hearing;

b. he or she must send a copy of the request to the person who requested the hearing and to all other persons who are parties to the hearing;

c. he or she must state facts that demonstrate that his or her participation in the hearing is in the interest of justice and will not impair the orderly conduct of the hearing;

d. he or she must designate the issues in which he or she has an interest.

2. The Fair Hearing official may waive the five day deadline for requesting intervenor status if there is good cause.

G. Informing the Assistance Unit

1. The Department issues and publicizes all Fair Hearing policies and procedures appearing in this section.

2. At the time of application and at the time of any action affecting the assistance unit's benefits, the Department informs the requester, in writing, of the following:

a. the requester's right to a Fair Hearing; and

b. the method by which the requester obtains a Fair Hearing; and

c. that the requester may be self-representative, may use legal counsel, a relative, friend, or other spokesperson; and

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 10-1-89 Transmittal: UP-89-46 1570.05 page 5 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS General Provisions ______________________________________________________________________________

1570.05 G. 2. Informing the Assistance Unit (continued)

d. the address of the local Legal Aid office, if there is free legal representation available.

H. Time Limits for Requesting a Fair Hearing

1. The request for a Fair Hearing must be made within a specified period of time from the date that the Department mails a notice of action.

a. For all programs except Food Stamps, this period is 60 days.

b. For the Food Stamp program, this period is 90 days.

2. Subject to the conditions described in this chapter, the requester has 10 days from the date the Department mails a notice of action to request a Fair Hearing in order to prevent termination or reduction of benefits before the Fair Hearing decision is rendered.

3. If the dispute involves a delay in action on an application, the assistance unit has the right to request a Fair Hearing as of the date the action becomes overdue, as described in this section.

4. If the dispute involves a delay or refusal to make a change, the requester has the right to request a Fair Hearing as of the date the change should have been made, as described in this section.

5. The requester's right to a Fair Hearing on the issue of delays extends for a period not to exceed 12 months from the date of application or date of requested change.

6. In the Food Stamp program, the assistance unit may request a Fair Hearing to dispute its current level of benefits at any time within a certification period.

I. Request for a Hearing

1. The request for a Fair Hearing must be in writing for all programs except the Food Stamp program. In the Food Stamp program, the request for a Fair Hearing may be written or oral.

2. The Department does not limit or interfere with the requester's freedom to submit a request for a Fair Hearing.

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 10-1-89 Transmittal: UP-89-46 1570.05 page 6 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS General Provisions ______________________________________________________________________________

1570.05 I Request for a Hearing (continued)

3. The Department helps the requester in submitting a Fair Hearing request if the requester is having difficulty in doing so. If the requester is Spanish-speaking, the Department explains the hearing procedures to him or her in Spanish.

J. Impartiality of Fair Hearing Official

The official conducting the Fair Hearing is an employee of the Department who is authorized by the Commissioner and:

1. has no personal stake or involvement in the case; and

2. was not directly involved in the initial determination of the action which is being contested; and

3. was not the immediate supervisor of the eligibility worker who took the action.

K. Group Hearings

1. The Department conducts a group hearing in response to a series of individual requests under the following conditions:

a. the sole issue involved is one of federal or state law or of Departmental policy; and

b. the request is made for a group hearing; or

c. the Department feels that a group hearing is appropriate and the requesters agree.

2. The policies and procedures concerning Fair Hearings, as outlined in this chapter, are the same for group hearings.

3. Each requester involved in a group hearing has the right to present his or her own case or be represented by his or her representative.

L. Resolution of the Fair Hearing Issue - Time Limits

1. The Department takes prompt, definitive, and final action in resolving the dispute. Final action includes the following:

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 10-1-89 Transmittal: UP-89-46 1570.05 page 7 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS General Provisions ______________________________________________________________________________

1570.05 L. 1. Resolution of the Fair Hearing Issue-Time limits (continued)

a. issuance of the Fair Hearing decision; and

b. notifying the requester of the decision; and

c. making any changes in the assistance unit's case as mandated by the Fair Hearing decision; and

d. notifying the requester of the changes.

2. The Department issues the Fair Hearing decision within a specified period of time. This period starts with the date the Department receives the request for a Fair Hearing.

a. for all programs except Food Stamps, the time period is 90 days;

b. for the Food Stamp program, the time period is 60 days.

3. When a request for an extension is made by the person who requested the Fair Hearing, the time limit for resolving the dispute is extended if the Fair Hearing is postponed. The extension period equals the number of days the Fair Hearing is postponed.

M. Issues Affecting More Than One Program

1. If the Fair Hearing issue affects the assistance unit's eligibility for both financial and medical assistance, a single decision serves to resolve the eligibility question for both programs.

2. If the Fair Hearing issue affects Food Stamp eligibility and eligibility under another program, one decision resolves the Food Stamp eligibility question and a separate decision resolves the eligibility question for the other program.

3. If the Fair Hearing issue involves eligibility for both Food Stamps and another program, the Department follows the guidelines concerning Fair Hearing time limits governing the other program, as described in this chapter.