THE TRUTH IS THAT OVER 73% OF ALL ALTCS APPLICATIONS ARE DENIED, SO YOU ARE NOT ALONE. IF YOU FEEL THAT YOU SHOULD NOT HAVE BEEN DENIED…
APPEAL – APPEAL – APPEAL!!
The eligibility hearing is an administrative process designed to ensure a fair and impartial review of an adverse action that is appealed. Adverse action is any action taken to deny or discontinue eligibility, a delay in an eligibility determination, an increase in the share of cost, or a reduction in services. A customer is entitled to a hearing for any adverse action resulting from eligibility decisions.
Eligibility hearings are heard by an Administrative Law Judge (ALJ) at the Office of Administrative Hearings (OAH). The hearings are held at 1400 West Washington in Phoenix, Arizona. Customers or their representatives may contact OAH at (602) 542-9826 or toll free at (877) 203-0226 if they have any questions or concerns. You may also check out the OAH website at www.azoah.com.
Approximately 75% of all eligibility hearings requested are resolved prior to the scheduled hearing. For this reason, it is very important not to delay in appealing the denial. You have only 45 days after the date of the decision to file the appeal. On the 46th day, you lose the right to appeal. Once the appeal is noted, the Eligibility worker will arrange for this “Pre-Hearing Discussion”. It is at this time that you can question the eligibility worker and substantiate your claim. This is very a very informal discussion. Do not be intimidated! If the application is still denied and you still want to appeal, you will continue on to the hearing with the Administrative Law Judge. You do not need to have an attorney – but if you wish to seek counsel prior to this hearing you can call JacksonWhite to discuss your options
You may request a hearing by:
1. Completing and submitting the request for hearing section found on the back of the Notice of Action; please see the attached sample of letter. It is important to submit this appeal request timely. This can also be faxed to the ALTCS office
2. Submitting a written request that contains at least the complainant’s name, the eligibility action on which the hearing request is based, and the reason for the hearing request; or
3. Calling the eligibility office and requesting a hearing, and then following up by submitting a written request.
Be an advocate for yourself. If you question the reason for denial, please feel free to call JacksonWhite Elder Law for a pre-screen. This pre-screen will help determine your appeal rights and validity of denial issue. This pre-screen process may be well worth your time. Remember that the application is held “open” during the appeal process so that the retroactive coverage may still apply.
DON’T GET DISCOURAGED- IF YOU FEEL YOU NEED THESE BENEFITS KEEP TRYING!