Fair & Fraud Hearings

Fair hearing activities are based on federal and state statutes, rules and regulations. When state-issued benefits or services are issued, ended, interrupted, denied or reduced, you'll receive a Notice of Case Action. This notice will describe the action and the reason the agency took the action.

If you don't agree with the action taken on your benefits, you can request an appeal for a fair hearing. Appeal requests must be made within 90 days, 120 for MCO appeals, from either the date of the case action or the effective date that is on the Notice of Case Action. Appeal requests submitted after the Federal and State timeframes will first be heard by a Fair Hearings Officer. If the Fair Hearings Officer determines good cause for the untimely appeal, then the Fair Hearing will be held. You may also ask for an appeal on a "non-action," which means you have submitted an application or a change to your benefits or services, but the agency has not completed the action in the required time.

Access the Fair and Fraud Hearings archive for past decisions here.

Requesting a Fair Hearing

The fair hearing process begins with asking for an appeal, which can be requested for many of the actions or inactions that happen to Supplemental Nutrition Assistant Program (SNAP) food benefits, Temporary Assistance for Needy Families (TANF), Medicaid, or other state-issued benefits or services. You can ask for an appeal in writing, by calling 2-1-1 or by visiting your local office. If the issue relates to your managed care organization (MCO) services, please contact your MCO service coordinator.

Once Texas Health and Human Services program staff, or the MCO receives the appeal request:

  • We forward it to the HHS Fair and Fraud Hearings Department.
  • Your appeal will be assigned to a Fair Hearings Officer and.
  • A Notice of Hearing will be mailed at least 14 days before the hearing date.

Most of the hearings in Texas are done by conference call. The Notice of Hearing will have the date and time of the hearing, a toll-free number and an access code for you to participate in the hearing. You must call in on time. The Hearings Officer will allow enough time for all parties to call into the hearing after the scheduled hearing start time. However, if you fail to call into the hearing after this time has passed, the Hearings Officer will close the hearing. If you don't call in before the Hearings Officer closes your hearing, they will dismiss your hearing for failure to appear.

Preparing for your Hearing

Before the hearing, the agency or managed care organization that took the action on appeal will send you all the information they’ll use in the fair hearing. You’ll receive policy excerpts and documents that the Agency used for their determination.

It’s important to look over this information and think of any questions or concerns you may have. If you have any documents you want to use in the hearing, send them to the Hearings Officer as soon as possible. You can find the Hearings Officer’s contact information on the Notice of Hearing. The Hearings Officer will send your information to the agency that took the action so they can review it before the hearing.

During the Hearing

The Hearings Officer will open the hearing and let everyone know it’s being recorded. Then:

  • Everyone will be placed under oath, and any documents or evidence will be offered, and all relevant documents admitted into the hearing record.
  • The agency or managed care organization representative will begin their testimony first since they must prove the action they took followed policy. This is called the “burden of proof.”
  • After the agency testifies, you can ask the agency any questions about their testimony. This is called "cross examination".

After the cross-examination of the agency, you’ll begin your testimony. When you’ve finished, the agency representative can ask you questions. The Hearings Officer may ask questions of you or the agency representative to get all the information they need to make a decision on the case. Once the Hearings Officer has all the information, they will close the hearing record and end the call.

After the Fair Hearing

The Hearings Officer has anywhere from 60–90 days from the appeal request date to issue a decision, depending on the program or benefits. They will either issue a sustained decision, meaning the action by the agency was upheld or sustained with instructions, meaning the agency action at the time of their decision was correct, but a change in you circumstances has occurred since, or a reversed decision, meaning the agency’s action was not correct and they must correct it.

If you aren’t satisfied with the Hearings Officer’s decision, you can ask for an administrative review or procedural review. This means an independent HHS Administrative Law Judge will review the hearing information and make sure the Hearings Officer followed policy when reaching their decision.

If you aren’t satisfied with an administrative review, you may file a judicial review in the Travis County District Courts for a judge to review the decisions of the Hearings Officer and the HHS Administrative Law Judge.

Fair Hearings Officer’s Role

The Hearings Officer has an important role to play in the hearing process as an unbiased moderator, of the fair hearing process and adjudicator. This means they can only consider the information presented in the hearing to decide which facts are relevant to the case. They must consider information that’s relevant to the action taken and the timeframe of that action. This means events happening after the agency action aren’t always considered during the hearing.

Although the Fair Hearings Officer are the final administrative decision makers, the don't  have unlimited power to grant benefits or make changes to benefits. They must follow the same policies and laws that govern the benefits.

Fair Hearings Officer’s Profile

The Fair and Fraud Hearings Department’s Fair Hearings Officers are exceptionally gifted, knowledgeable, and highly qualified individuals, with a deep understanding of State and Federal rules, regulations and policy, and vast agency experience. From attorneys, nurses and educators, to experienced program staff, Fair Hearings Officers come from all walks of life.

Hearings Officer’s Oath

I, do solemnly swear (or affirm) that I will support the mission of the Health and Human Services Commission’s Fair and Fraud Hearings Department to provide an accessible, neutral forum for conducting administrative hearings for Texans; that I will faithfully and impartially discharge and perform all the duties incumbent upon me; that I will issue just and impartial decisions with respect for the dignity of individuals and their due process rights; that I will honestly demean myself in the exercise of my duties; and that I will conduct myself with integrity and civility in dealing and communicating with all parties.