Effective Date: April 1, 2014

Previous Policy

Applicants and enrollees have the right to ask for a fair hearing if they disagree with the agency's decision about eligibility for CHIP benefits.

An applicant or enrollee must request a hearing in writing or orally within 90 days of the date of the notice of agency action with which he disagrees.

The applicant or enrollee must submit a written or verbal request to the Department of Workforce Services Fair Hearing Team. The enrollee must make the request by the close of business on the 90th day, or if the 90th day is a non-business day, by the close of business on the first business day following the 90th day.

Enrollees receive continued CHIP benefits pending a hearing decision if they request a fair hearing before the effective date of the action or within 10 calendar days of the receipt of the notice, whichever is longer. The notice is considered to be received 5 days from the date on the notice, unless the recipient can show they did not receive the notice within the 5 day period. See 120-5 .

An enrollee has the right to refuse continued benefits pending a hearing decision.

The enrollee must repay any benefits received pending the hearing decision if the hearing decision upholds the agency action. See 120-5 .

An enrollee, an enrollee’s spouse, an enrollee’s parent or an authorized representative may request a hearing.