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23.2 Fair Hearings Applicants and members have the right to a fair hearing, timely case decisions, and accurate notices of decision. Hearings are conducted by the Wisconsin Department of Administration, Division of Hearings and Appeals (DHA) for Medicaid. Hearings serve to: 1. Interpret the program to applicants and members who disagree with the agency’s action. 2. Bring the applicant or member and the agency into discussion for a better understanding of problems. 3. Resolve factual disputes. 4. Clarify policies and their application in relation to laws and regulations. 5. Review policies in program administration and reveal those which require clarification or revision. 6. Promptly remedy unfair treatment, mistaken or arbitrary action and negligence. 23.2.1 Resolution Prior to Hearing When an applicant or member disagrees with an agency's action, the applicant or member may contact their agency to attempt to resolve the issue. This may be done through the normal modes of communication between the applicant or member and the agency, such as a phone call or in-person visit. It also may be done through an agency conference where the applicant or member meets with the worker responsible for the agency's action or other agency representatives. This contact with the agency does not affect the applicant or member’s right to a fair hearing or the time limit for requesting a fair hearing. The agency must advise the applicant or member that to have an agency conference is the applicant or member’s choice and doesn't delay or replace a fair hearing. The applicant or member may request a hearing without first contacting the agency. Note If the applicant or member requested a fair hearing, the fair hearing process will continue unless the applicant or member voluntarily withdraws the hearing request in writing to DHA (see SECTION 23.2.8 WITHDRAWAL OF FAIR HEARING REQUEST). 23.2.2 Fair Hearing Request For Medicaid, the applicant, member, or representative may request a fair hearing in writing by filling out the Request for a Fair Hearing (DHS-28) form or writing a letter with the request and sending it to the DHA.

Division of Hearings and Appeals P.O. Box 7875 Madison, WI 53707-7875

Fax (608) 264-9885

Email: DHAMail@wisconsin.gov DHA will schedule a hearing upon receipt of the hearing request. DHA has jurisdiction to conduct hearings for Medicaid if the request is received by DHA within 45 days of the action effective date. DHA may dismiss a request if the action being appealed is a result of a change in federal or state law or policy