The Texas Health and Human Services Commission (HHSC) Fair and Fraud Hearings Department (FFH) receives appeal requests from applicants and clients contesting decisions concerning benefits and services of several programs.
These programs include the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), all Medicaid-funded services, and other programs that are required by state or federal law or rules to provide the right to a fair hearing.
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 will receive a Notice of Case Action. This notice will describe the action and the reason the agency took the action.
Most appeal requests must be made within 90 days, or 120 days for managed care organizations (MCOs), from either the date of the case action or the effective date on the Notice of Case Action. Appeal requests submitted after the 90 or 120 day time frames will be reviewed for good cause for an untimely appeal and whether the fair hearing will be held.
Hearings officers conduct hearings, consider evidence and issue decisions in accordance with rules, regulations, and state and federal law.
The Fair and Fraud Hearings Handbook provides guidance on the appeal process for applicants, clients, client representatives, program representatives and hearings officers.
HHSC Fair and Fraud Hearings currently has 49 staff members. In 2022, the office received 30,191 appeals and issued 29,532 decisions.
Fraud hearings are conducted for two programs: SNAP and TANF. The Office of Inspector General (OIG) is responsible for investigating intentional program violations. If an alleged violation is found, the OIG will send a referral to FFH for an Administrative Disqualification Hearing.
Request 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 SNAP, TANF, Medicaid, or other state-issued benefits or services.
An appeal request can be made in writing, by calling 2-1-1 or by visiting a local HHSC office. If the issue relates to your managed care organization services, contact your MCO service coordinator.
Prepare for Your Hearing
Fair and fraud hearings are typically conducted by conference call. FFH will mail a Notice of Hearing to the hearing participants with the date and time of the hearing, a toll-free number and an access code. Hearing participants call into the hearing, and the hearings officer will allow enough time for all parties to submit evidence and provide testimony regarding the issue on appeal.
Once the hearing is scheduled, the agency representative or MCO representative will mail a packet with the information that will be presented in the hearing as evidence. The packet will contain policy excerpts and documents that the agency used for the action on appeal.
The hearings officer’s contact information will be located on the Notice of Hearing. An appellant (person requesting the appeal), respondent or authorized representative can provide any documents before the hearing to the hearings officer that they wish to present or discuss regarding the action on appeal. The hearings officer will share that evidence with the agency representative prior to the hearing.
If you don’t call into the hearing at the scheduled date and time, the hearings officer will close the hearing. If you do not call in before the hearings officer closes your hearing, the hearings officer will dismiss your hearing for failure to appear.
During the Hearing
- The hearings officer will open the hearing and let everyone know the hearing is being recorded.
- The hearing participants will be placed under oath, any documents or evidence will be offered and all relevant documents will be admitted into the hearing record.
- The agency representative or MCO representative will present evidence first. The agency has the burden of proof, which is the responsibility to submit evidence to establish that the action that was taken was correct and in accordance with the rules and regulations. Any agency witnesses could be called on to provide testimony.
- After the agency representative testifies, the hearings officer will permit the appellant or the appellant’s representative to ask the agency questions or begin their testimony. The appellant or appellant’s representative will have the opportunity to present their evidence.
- The hearings officer may ask questions to further develop the record and decide on the case. Once the hearings officer has all the information, the hearing record will be closed.
After the Hearing
The hearings officer has 60 to 90 days from the appeal request date to issue a decision depending on the program or benefits. The hearings officer will issue one of the following decisions:
- A sustained decision, meaning the action by the agency was upheld.
- A sustained with instructions decision, meaning the agency action at the time of its decision was correct, but additional action is needed.
- A reversed decision, meaning the agency’s action was not appropriate.
If the appellant or the appellant’s authorized representative is not satisfied with the hearings officer’s decision, the written decision will provide instruction for an administrative review or procedural review. This means an independent HHSC administrative law judge will review the hearing testimony and evidence available to the hearings officer when the decision was issued and will issue a new decision to uphold or reverse the hearings officer’s decision.
If an appellant does not agree with the administrative review decision, they can file a request for a judicial review with the district court in Travis County within 30 days of the date of the administrative review decision.
Fair and Fraud Hearings Mission
The mission of HHSC and FFH is to provide an accessible, neutral forum for conducting administrative hearings for Texans while issuing just and impartial decisions with respect for the dignity of people and their due process rights.
The hearings officer is an unbiased moderator and adjudicator of the fair hearing process. The Hearings Officer is responsible for:
- Holding a fair, impartial and unbiased hearing while following informal adjudicative rules.
- Ensuring the hearing is conducted fairly, objectively and in an orderly manner.
If you have questions about your administrative hearing or the appeals process after you have tried to get information from the Appeals Division, please contact the HHS Office of the Ombudsman at 877-787-8999.