1200, Notice

Revision 10-1; Effective January 15, 2010

1210 Notice of Proposed Adverse Action — 1 TAC §357.11

Revision 10-1; Effective January 15, 2010

The HHS agency follows notice requirements set forth in the appropriate state or federal law or regulations for the individual program. A notice must be sent to the client when a denial or reduction in services or eligibility action is taken. The notice must advise the client of the right to a fair hearing, how to request an appeal, the right to be represented by others, including legal counsel, available legal services in the community and an explanation of the circumstances when continued benefits may be available.

1220 Content of Notice – 1 TAC §357.11

Revision 11-4; Effective June 1, 2011

According to 45 CFR §431.210, relating to notice requirements for Medicaid-funded programs, "a notice is required under §431.206(c)(2), (c)(4) and must contain:

  • A statement of what action the state, skilled nursing facility or nursing facility intends to take;
  • The reasons for the intended action;
  • The specific regulations that support, or the change in federal or state law that requires, the action;
  • An explanation of:
    • The individual's right to request an evidentiary hearing if one is available, or a state agency hearing; or
    • In cases of an action based on a change in law, the circumstances under which a hearing will be granted;
  • An explanation of the circumstances under which Medicaid is continued if a hearing is requested."

    In addition, denials or reductions of services provided to Medicaid clients under age 21, the Alberto N. settlement requires an explanation of why the request for services was denied and where appropriate, how to obtain services through other programs.

According to 7 CFR §473.13, relating to notices required for SNAP, "The notice of adverse action shall be considered adequate if it explains in easily understandable language:

  • the proposed action;
  • the reason for the proposed action;
  • the household's right to request a fair hearing;
  • the telephone number of the food stamp office (toll-free number or a number where collect calls will be accepted for households outside the local calling area) and, if possible,
    • the name of the person to contact for additional information;
    • the availability of continued benefits; and
    • the liability of the household for any over issuances received while awaiting a fair hearing if the hearing official's decision is adverse to the household. If there is an individual or organization available that provides free legal representation, the notice shall also advise the household of the availability of the service."

1230 Right to a Fair Hearing — 1 TAC §357.3(b)

Revision 11-4; Effective June 1, 2011

Clients of Medicaid-funded services, TANF, SNAP and other agency programs in which state or federal law or rules provide a right to a fair hearing, are entitled to appeal the following procedures:

  • an action to reduce, suspend, terminate or deny benefits or eligibility;
  • a failure to act with reasonable promptness on a client's claim for benefits or services;
  • a decision to transfer or discharge a resident from a skilled nursing facility or nursing facility;
  • an adverse determination made regarding Preadmission Screening and Resident Review;
  • the denial of a prior authorization request;
  • the failure to receive a service authorization request;
  • the failure to reach a service authorization decision within the time period specified by federal law; and
  • an action taken to recoup benefits previously paid to a recipient.

A client may appeal more than one action at the same time, in writing or orally unless specified in program rules or notices.

Issues related to non-payment of a claim to a provider are not appealable.

When an appellant dies during the appeal process, if the legal representative of the decedent's estate does not pursue the appeal, the hearings officer may consider the appeal withdrawn.

Three limitations apply to the right to request a fair hearing.

  • A SNAP household can contest the SNAP benefit amount by requesting a fair hearing when it is aggrieved by a mass change in benefits.
  • A client may appeal the application to him of an across-the-board reduction in benefits or services on the grounds that the mass change does not apply to him.
  • Under all programs, the agency is not required to grant a hearing if the sole issue is a federal or state law requiring an automatic mass change adversely affecting some or all clients. This may be determined at a pre-hearing conference.

Note: HHS agency staff may not prevent a client from filing an appeal because staff believe that the item, services or benefit is not subject to appeal. The hearings officer determines if an issue is appealable.

1240 Time Period for Requesting a Fair Hearing — 1 TAC §357.3(b)(2)

Revision 11-4; Effective June 1, 2011

The appellant has a right to file an appeal within 90 calendar days from the effective date of the action or from the notice of adverse action date, whichever is later.


  • Pursuant to 7 CFR §273.15(g), a client may appeal his current level of SNAP benefits at any time during a certification period. A SNAP client may also appeal the denial of a request to restore benefits that were lost within one year prior to the request.
  • According to program rules found in Title 40, Texas Administrative Code (TAC), Part 1, Chapter 19, Subchapter F, §19.502, a nursing facility resident who has received notice of a transfer or discharge has 10 days from the date of the notice to request an appeal. The hearings officer should review the notice to ensure that the nursing facility resident's rights were protected. Determination of good cause for failure to file a timely request for appeal applies.
  • According to program rules in Title 1, TAC, Part 15, Chapter 375, Subchapter D, a participant in the Refugee Cash Assistance Program has 10 days from date of notice to request a fair hearing.
  • According to program rules at Title 1, TAC, Part 15, Chapter 386, Subchapter D, §386.408, a participant in the Disaster Assistance program has 60 days from the date on the reconsideration decision letter to request a fair hearing.

Note: HHS agency staff may not prevent a client from filing an appeal because staff believe that the appeal was not requested within the required number of calendar days. The hearings officer is the final authority regarding the timeliness of filed appeals and accepts appeals filed after the time limit in order to determine whether there was good cause for the delay in filing.

If a request for a hearing is not received within the required time frame and the hearings officer determines good cause was not established for the failure to file timely, the individual has forfeited the right to a fair hearing and the agency action becomes final.