Page 13

Official source

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 13 Effective Month: July 2025 100.04.01 THE HEARING PROCESS Hearings Defined A fair hearing is an orderly, but informal meeting in which an individual is afforded an opportunity to address an impartial hearing officer for the purpose of presenting oral testimony and/or evidence of his entitlement to medical assistance and services. The individual has the right of confrontation and cross-examination as described further in this section. A fair hearing is a de novo hearing which means it starts over from the beginning. A new determination of eligibility is made based on all the evidence that can be secured, without regard to whether the evidence was available at the time the regional office acted. Thus, the process is not essentially different from a determination of eligibility. Types of Hearings The individual may request to present an appeal through a local-level standard or expedited hearing, a state-level standard or expedited hearing, or both. In an attempt to resolve issues at the lowest level possible, offices should encourage individuals to request a local hearing first. The only exception to requesting a local hearing is when the issue under appeal involves disability, blindness or level of care. Therefore, the actions below which involve medical decisions cannot be addressed in a local hearing. A state hearing must be requested for: • A disability or blindness denial or termination, or • A level of care denial or termination for the Katie Beckett Program. Hearing Methods Local and/or state level hearings (standard or expedited) will be held by telephone unless, at the discretion of the hearing officer, it is determined that an in-person hearing is necessary.

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Page 13

Official source

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 13 Effective Month: July 2025 100.04.01 THE HEARING PROCESS Hearings Defined A fair hearing is an orderly, but informal meeting in which an individual is afforded an opportunity to address an impartial hearing officer for the purpose of presenting oral testimony and/or evidence of his entitlement to medical assistance and services. The individual has the right of confrontation and cross-examination as described further in this section. A fair hearing is a de novo hearing which means it starts over from the beginning. A new determination of eligibility is made based on all the evidence that can be secured, without regard to whether the evidence was available at the time the regional office acted. Thus, the process is not essentially different from a determination of eligibility. Types of Hearings The individual may request to present an appeal through a local-level standard or expedited hearing, a state-level standard or expedited hearing, or both. In an attempt to resolve issues at the lowest level possible, offices should encourage individuals to request a local hearing first. The only exception to requesting a local hearing is when the issue under appeal involves disability, blindness or level of care. Therefore, the actions below which involve medical decisions cannot be addressed in a local hearing. A state hearing must be requested for: • A disability or blindness denial or termination, or • A level of care denial or termination for the Katie Beckett Program. Hearing Methods Local and/or state level hearings (standard or expedited) will be held by telephone unless, at the discretion of the hearing officer, it is determined that an in-person hearing is necessary.