Frequently Asked Questions – Client

Revision 22-1; February 23, 2022

How do I contact the Fair and Fraud Hearings Department?

If you have received a Notice of Hearing regarding your appeal, the contact information is at the top of the page. If you have not received a notice, you may contact 2-1-1 or the Fair and Fraud Hearings Department at 512-231-5701, via email at OCC_Appeals_FairandFraudHearings@hhsc.state.tx.us or by fax at 512-231-5743. 

How do I file an appeal?

If you have received a Notice of Agency Action, instructions for requesting an appeal are included on the notice. If you have not received a notice, you may contact 2-1-1 or visit your local office. An appeal may be requested in person, by telephone, fax or mail. You also may appeal if the agency fails to take action on a request for services.

Who will hear my appeal?

Appeals are heard by fair hearings officers across the state. A fair hearings officer has an important role to play 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 time frame of that action. This means events happening after the agency action aren’t always considered during the hearing.

Will I be contacted for my scheduled hearing or how do I participate?

Yes, the agency representative is required to send a copy of the documents to be used at your hearing to both you and the hearings officer before the hearing. 

When will I receive a decision on my hearing?

Fair hearings officers must not take longer than the established federal timelines, depending on the program, to issue a decision.  There are circumstances that could result in an extension of these time frames. For example, for Supplemental Nutrition Assistance Program (SNAP) decisions, the time frame is 60 days. For all other programs, in general, the time frame is 90 days. The actual due date will be provided by the hearings officer at the time of the hearing.  

What can I do if I disagree with the hearings officer’s decision?

You may request an administrative or procedural review if you do not agree with the hearings officer’s decision. An administrative review is a review of the hearing record by a Health and Human Services Commission (HHSC) administrative law judge (ALJ). The ALJ will issue a new decision after reviewing the record and may sustain or reverse the hearings officer’s decision. A procedural review is a review of the hearing record by an HHSC Regional Legal Services attorney on cases not subject to administrative review. However, a procedural review does not change the outcome of the hearing.

Can program staff resolve the issue on appeal before the actual hearing?

Yes. If during a review of the case, prior to the hearing, program staff discover an error or you provide additional information, they may correct the case and notify you. Note: You can reapply for benefits at any time before the hearing.

What is a pre-hearing conference and why would one be scheduled?

The pre-hearing conference is an informal legal proceeding that is scheduled by the hearings officer to resolve issues of procedure, jurisdiction or representation, or to clarify other issues prior to the fair hearing. 

How can I prepare for the hearing? Am I required to send any information?

In order to prepare for the hearing, you can review the documents the agency representative will be using at the hearing. 

You are not required to send any information. If you have any documents you would like the hearings officer to consider, you may send them to the hearings officer before the hearing. Additional information on time frames can be found on the Notice of Hearing. 

What do I do if I need interpreter services, sign language assistance or other special accommodations?

At the time you file your appeal request, or before the date of your fair hearing, you should let the fair hearings officer know that you require assistance or special accommodations. Doing so will help avoid delays in the process or the need to reschedule your appeal. 

Can I bring my child, a relative or a friend as an interpreter?

You may bring any person you would like to assist you with presenting your case. However, the Fair and Fraud Hearings Department will provide a qualified interpreter during the hearing, when requested.

Can I speak to the hearings officer before the hearing?

Generally, no, the hearings officer may not speak to either party of an appeal throughout the appeals process. However, you may speak with their administrative assistant regarding procedural matters, if needed. This ensures a fair and unbiased hearing for all involved parties.

What can I do if I do not understand the hearings officer’s decision?

The cover letter sent with the hearing decision includes a phone number you may call if you do not understand the decision.

Can I apply for benefits if I have an appeal pending?

Generally, yes, you may apply for benefits at any time and do not have to wait for your hearing or a hearing decision. However, this will depend on the program and agency you are requesting benefits for.

Can I receive continued benefits pending the outcome of my appeal?

Depending on the program and when you request an appeal, you may be able to receive continued benefits pending the outcome of the appeal.

If I get continued benefits with my appeal, do I have to repay any continued benefits I received?

The agency may ask you to pay back the money spent providing continued benefits if the fair hearings officer upholds the action taken by the agency.

Can someone represent me in a hearing? Can others participate with me at the hearing?

You have the right to ask someone to represent you at the hearing and to help you state your case. You also may invite other individuals who may provide additional information. However, the hearings officer may limit the number of participants in a hearing.

What is the time frame to file an appeal?

You have 90 days from the date of the denial notice to request a fair hearing. If the agency that took action on your case is a managed care organization (MCO), you have 120 days to request a fair hearing from the date the MCO internal appeal has been completed.   

What if I missed the time frame for requesting an appeal?

You still may request an appeal after the 90-day time frame; however, you will need to tell the fair hearings officer why you failed to request the appeal within the time frame. The fair hearings officer will decide if you had good cause for not timely submitting the appeal. 

What if I missed my hearing?

If you missed your hearing, the hearings officer will dismiss the request for a fair hearing. You will have 30 days from the date of the decision to ask the hearings officer to reopen your appeal. You will need to explain in writing why you missed the hearing.

Do I have to attend in person?

No, unless you request a face-to-face hearing. Most hearings are held by telephone.

What if I am not available on the date and time of my hearing?

If you know you will be unavailable for the date and time stated in the Notice of Hearing, you can call the hearings office, before the hearing, at the telephone number listed at the top of the Notice of Hearing to ask that the hearing be rescheduled. You can also send a written request to the hearings officer using the form provided with your Notice of Hearing. Unless you receive a notice of new appointment, you are expected to participate in the scheduled hearing. 

What happens if I forget to tell the hearings officer something?

You may mail the additional information to the hearings officer at the address listed on the Notice of Hearing. If the hearings officer determines the information is relevant to the case, the information will be shared and the hearing may be reconvened.

What can I expect in a fair hearing?

Once everyone is in attendance, the hearings officer will explain what will happen and swear everyone in. Then, the agency representative will explain the action they took on your case. You will then have a chance to ask questions and explain why you disagree with the action or inaction taken by the agency.

What kinds of appeals are heard by the Fair and Fraud Hearings Department?

Hearings officers hear appeals for programs administered by HHSC and HHS System agencies, including the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) and Medicaid-funded services.  

How do I know the appeal process is fair?

The hearings officer is required by state and federal law to be impartial and must be a person who has no prior knowledge of the case. The hearings officer may only consider evidence and testimony provided at the hearing when making a decision on the case.

How many times can I appeal the same issue?

If you are not satisfied with the action taken by the agency, you may request an appeal. If you disagree with the hearings officer’s decision, you may request an administrative review. If you disagree with the outcome of the administrative review, you may request a judicial review by filing in the district courts in Travis County.

How do I ask for a pre-hearing conference?

You may contact the Fair and Fraud Hearings Department staff by calling the telephone number at the top of the Notice of Hearing and asking for a pre-hearing conference to address procedural issues. The hearings officer may schedule a pre-hearing conference to resolve issues.

How long does a hearing last?

The length of the hearing depends on the complexity and type of issue on appeal. You should plan on a minimum of one hour. 

Do I have to have an attorney?

No, you do not need to have an attorney, but you may have an attorney represent you at the hearing at your own expense. For free legal assistance, contact your local legal aid office. You may find additional information regarding your local legal aid office in the Notice of Hearing.

Can I record the hearing?

Yes, you may record the hearing. However, the “official” record of the hearing is the recording made by the hearings officer.

How do I get a copy of the hearing recording?

You may request a copy of the hearing recording from the hearings officer.

How do I get a copy of my case file?

A copy of the documents used to make the decision on the issue on appeal will be sent to you before the hearing. To obtain a copy of your entire case file, you may contact your caseworker, your caseworker’s supervisor, the Office of the Ombudsman or the hearings officer.

Are program staff allowed to work on any new actions while an appeal is pending?

Program staff may process any new actions, such as processing a new application or a reported change.