Appeal an HHS Decision
Anyone has the right to appeal any decision made by the Department of Health and Human Services (HHS) and to request an appeal hearing. No one may limit or interfere with this right.
Filing an appeal is an easy thing to do. Supplemental Nutrition Assistance Program (SNAP), Medicaid, Child Care Assistance, Family Planning Program, and Family Investment Program appeals may be made in person, by telephone or in writing. All other appeals must be requested in writing.
You can write a letter explaining the reason you disagree with the Department's decision or you can complete an Appeal and Request for Hearing form online at Appeal and Request for Hearing English version or Appeal and Request for Hearing Spanish version.
You can request this form from your worker or you can complete your request online. You can use the Appeal and Request for Hearing English version or the Appeal and Request for Hearing Spanish version. Please fill out the entire form and click the submit button at the bottom of the form. Your appeal request will be sent directly to Appeals. Your worker will be notified of your appeal request, if applicable.
If you have questions on how to complete the Appeal and Request for Hearing form, you may call Appeals at 1-888-723-9637.
If you are writing a letter or you do not want to complete this form on-line, you can send or take your appeal request to your local office or you can submit it directly to Appeals:
You must file an appeal within the timeframes listed. The time starts from the date on your Notice of Decision.
- Family Investment Program (FIP) state tax or debtor offset - 15 days
- SNAP state tax or debtor offset - 15 days
- Medicaid state tax or debtor offset - 15 days
- Child Support state or federal tax or debtor offset - 15 days
- SNAP - 90 days
- Medicaid eligibility – 90 days
- Medicaid fee-for-service coverage – 90 days
- Family planning program – 90 days
- Autism support program – 90 days
- Managed care organization health care decisions – 120 days from the date on the letter indicating the first-level review process has been exhausted
- Child abuse assessments - 90 days from the date on the Notice of Child Abuse Assessment
- Adult abuse assessments – 6 months from the date on the Adult Protective Notification
- All other appealable issues - 30 days or before the effective date of the adverse action
When the time limit for filing falls on a holiday or a weekend, the time will be extended to the next working day.
If you file your appeal within the appropriate timeframe and the Department determines you are eligible for a hearing, a hearing will be scheduled for you.
However, if any appeal is filed after the appropriate timeframe, but before 90 days, a hearing may still be granted if you are able to claim good cause. You do not have to show good cause for filing a SNAP, Medicaid eligibility, Medicaid fee-for-service, family planning program, or autism support program or child abuse appeal within the 90-day timeframe.
Any appeals filed after 90 days will not be granted a hearing, unless the appeal is related to adult abuse or a managed care organization decision. Any appeals filed after 6 months for adult abuse will not be granted a hearing. Any appeals filed after 120 days for a managed care organization health care decision will not be granted a hearing.
If your appeal is not filed within the timeframes listed above, but less than 90 days, a hearing may still be granted.
A hearing may be granted if one of the following reasons kept you from filing your appeal within the appropriate timeframes:
- A serious illness or death in your family.
- A family emergency or household disaster, such as a fire, flood or tornado.
- A failure to receive the Department's notice of adverse action for a reason beyond your control. (Failure to notify the Department you moved will not be considered.)
- Other good cause beyond your control.
If you want to claim good cause, you will need to send a written request explaining why you were unable to file your appeal within the appropriate timeframes. You will need to include written proof of your good cause claim. Written proof includes such things as funeral notices, letters from physicians, newspaper articles, etc. that explain why you could not file your appeal timely. Send your request to:
Department of Health and Human Services
1305 E Walnut St, 5th Floor
Des Moines, IA 50319
FAX (515) 564-4044
If you have questions, you may call Appeals at 1-888-723-9637.
If it is determined that you had good cause, your appeal will be scheduled for a hearing. A letter will be sent to you if it is determined that you do not have good cause. You may appeal the denial of your good cause claim. Please follow the instructions in your letter to file an appeal. If you appeal that letter, a hearing will be scheduled with an Administrative Law Judge to determine if the Department correctly denied your good cause claim. The hearing will not be about the merits of your case.
When someone disagrees with an action taken by a managed care organization, federal regulations allow members, providers or authorized representatives to file an appeal. If a provider or authorized representative files an appeal, the Medicaid member must have given their express written consent before the appeal can proceed to a state fair hearing.
Member consent must be obtained on form 470-5526, Authorized Representative for Managed Care Appeals. Form 470-5526 shall be used to appoint an individual, organization or provider to act on behalf of the Medicaid member during the appeals process. Both the member and the provider, or the authorized representative must sign the form to make it valid. The form is required for the managed care organization (MCO) and dental carriers’ first level appeals process and for the Department’s state fair hearing process, and should be submitted with the appeal request.
Form 470-5526 includes the contact information for each MCO, dental carrier and HHS Appeals.
Federal regulations and the managed care contract do not allow providers to file appeals with HHS Appeals regarding claims payment disputes or post-service provider issues.
First level review is a review process that must be exhausted through a managed care organization before an appeal hearing is granted. The first level review process is mandated by federal regulations.
The managed care organization will review information submitted by the Medicaid member and the member’s medical provider to make a decision on the first level review. Once this process is complete, a notice of decision will be issued by the managed care organization that explains the right to request a state fair hearing.
If a request for state fair hearing is filed before the first level review is complete, the state fair hearing request will be denied and HHS Appeals will ask the MCO to initiate a first level review, if applicable.
A state fair hearing request is filed with HHS Appeals. Staff will obtain a copy of the first level review outcome letter from the managed care organization. HHS Appeals will review the request to ensure it was filed timely and that member’s consent has been obtained, if the request was filed by a provider or authorized representative. If all hearing requirements are met, the appeal file is forwarded to the Department of Inspections, Appeals and Licensing so an appeal hearing can be scheduled.
If the request for a state fair hearing is denied as premature, HHS Appeals will forward the request to the managed care organization so the first-level review process can be initiated.
Reconsideration is a review of the situation by a third party who was not involved in making the initial decision.
When you file an appeal for certain programs, you will need to complete the reconsideration process first.
If your appeal is denied as being premature, the denial letter will instruct you on how to complete the reconsideration process.
NOTE: The reconsideration process does not apply to child abuse or managed care appeals.
After Appeal is Filed
Iowa HHS Appeals will review each appeal to see if a hearing can be granted. Each appeal must meet the following criteria:
- The Department has taken an action that can be appealed.
- The Department has issued a written notice about the negative action.
- You filed your appeal:
- Within 15 calendar days for tax/debtor offsets.
- Within 90 calendar days of the written notice for SNAP and Medicaid eligibility or fee for service actions.
- Within 90 calendar days for a child abuse assessment.
- Within 120 calendar days for managed care organization or dental carrier actions.
- Within 6 months for an adult abuse assessment.
- Within 30 calendar days of the written notice for all other programs.
For managed care organization appeals, Appeals will also:
- Confirm that the first level review process through the managed care organization has been exhausted, and
- Member has provided written authorization for the provider to file an appeal on their behalf, if applicable.
If you are eligible for a hearing, your appeal file will be sent to the the Administrative Hearings Division of the Iowa Department of Inspections, Appeals and Licensing. They will schedule a telephone hearing and send you a written notice of the date and time.
If you do not get a hearing, a letter will be sent to you telling you why your appeal was denied.
You can file a new application at any time. If your situation changes during the appeal, contact your HHS worker and ask to reapply right away.
You may be eligible for assistance even if the administrative law judge hasn't made a decision yet.
You may continue to get benefits while your appeal is pending, however, any benefits you get while an appeal is pending may be subject to recovery. If the Department is found to have acted correctly, you will be responsible for repaying the Department for any assistance that you were not entitled to while your appeal was pending. If the Department is found to have acted incorrectly, you may not have to repay funds received while an appeal is pending.
You can choose not to have benefits continue while your appeal is pending. If you choose not to, you should indicate that on the Appeal and Request for Hearing form.
The Department’s regulations define the criteria that is used to determine if benefits can continue while an appeal is pending. The criteria differs based on the type of assistance you receive.
Supplemental Nutrition Assistance Program (SNAP):
Your SNAP benefits may continue pending a final decision on your appeal when you ask for an appeal hearing within 10 calendar days from the date of the Notice of Decision that reduced, suspended, restricted or canceled your benefits was received. The date the notice is received is considered to be 5 days after the date on the notice, unless you show that you did not receive the notice within the 5 day period.
Managed Care Organization:
Health care services may continue pending a final decision on your appeal when:
- An appeal is filed timely. Timely means the appeal is filed on or before the effective date of the adverse benefit determination or within 10 calendar days from the date of the managed care organization’s notice reducing, limiting, suspending, or canceling health care services was received. The date the notice is received is considered to be 5 days after the date on the notice, unless you show that you did not receive the notice within the 5 day period;
- The appeal involves the termination, suspension or reduction of a previously authorized course of treatment;
- The services were ordered by an authorized provider;
- The original period covered by the original authorization has not expired, or
- The appellant requests their health care services be continued.
If the managed care organization continue or reinstates the member’s health care services while the appeal is pending, the benefits will continue until:
- The appellant withdraws the appeal.
- The appellant fails to request an appeal within ten calendar days from the date the managed care organization mails the notice of action.
- The authorization for services expires or authorization service limtis are met.
- A hearing decision is issued that is adverse to the appellant.
For all other programs, benefits may continue if:
- You file your appeal within 10 days from the date of the Notice of Decision that reduced, suspended, restricted, revoked, canceled, or denied assistance to you or your household was received. The date the notice is received is considered to be 5 days after the date on the notice, unless the appellant shows that he or she did not receive the notice within the 5 day period.
- You file your appeal before the effective date on the Notice of Decision, unless your certification period has ended.
If the issue of your appeal has been resolved or you no longer want to pursue the appeal, you may request to withdraw your appeal.
To request to withdraw an appeal, you may do so by telephone, in writing or in person. For child abuse and dependent adult abuse appeals, the request to withdraw must be done in writing and signed by the appellant and their legal counsel.
You may write a letter explaining that you wish to withdraw your appeal and mail, fax or email your request or you may complete the form Request to Withdraw Appeal online. Please complete the entire form and click the submit button at the bottom of the form. Your request to withdraw your appeal will be sent directly to HHS Appeals. Your worker will be notified of your request, if applicable.
You will get a letter from the Appeals Section indicating that your request was received.
If a hearing has already been scheduled, you may submit a written request to the Administrative Law Judge directly to let them know you are no longer interested in having a hearing.
Before the appeal hearing starts, think about the issue of the appeal and the arguments that you want to make. Also, make a note of any questions that you want to ask the Department when it is your turn.
You may want to use this opportunity to review your case file. Contact your HHS worker to set up a time to do so.
The Department will send you a copy of their appeal summary and any other documentation that they anticipate using during the appeal hearing. The Administrative Law Judge will have the same information to look at during the hearing.
Be sure to have the Department's exhibits with you when you are participating in the hearing so you can look at them.
If you have any supporting documentation that you want to include in the hearing, be sure to mail or fax that information to the Administrative Law Judge. The judge's address and fax number will be on your Notice of Hearing. The material must be sent in at least five working days before the hearing.
This information may be submitted as evidence, which may be used by the Administrative Law Judge when making a decision about your appeal.
Your appeal hearing will likely be held by telephone conferencing system. The department's representative and anyone else who is required to be involved will also be a part of your appeal hearing.
You can participate in the hearing from any location. Please see the instructions on the notice of telephone hearing to see how to use the conference system.
It is your responsibility to call in for the hearing. The judge will not call you. If you do not call using the instructions on the notice of telephone hearing you will not be able to participate in the hearing. If you have an attorney or someone else helping you with your appeal, that person will also need to call into the number listed on the notice of hearing to join the appeal hearing.
You may call in as early as five minutes before your hearing is scheduled to begin. The judge will wait five minutes after the time the hearing is scheduled to start to allow all parties to call in. If you have not called in by five minutes after the hearing is scheduled to start, the judge may dismiss your appeal and you may lose your right to participate.
If you do not have a phone or you want your hearing to be held at the DHS local office or at a child support office, please contact your worker and the judge at least five working days before your hearing. This will give your worker time to find a room for the hearing.
You have the right to look at your case file and any other papers the agency will be using during the appeal hearing. You will need to contact your HHS worker to set up a time to look at your case file.
If you need an interpreter at the hearing, you can indicate this on the Appeal and Request for Hearing form when you file an appeal. You may also call your HHS worker and request an interpreter. You will not be able to use a child or other family member as your interpreter.
An informal conference is a type of meeting between your worker, your worker's supervisor, any other representatives of the Department, your attorney or representative unless prohibited by law, and you. This should be held shortly after the appeal is filed.
The purpose of the informal conference is to give you a chance to ask questions, explain the reason you filed an appeal, and give you a chance to review your case file.
You do not need to request an informal conference to review your file. You will need to contact your worker to set up a time to do so.
If the issue is resolved during the informal conference, you can request to withdraw your appeal. If you do withdraw your appeal, an appeal hearing will not be scheduled for you. No one can force you to withdraw your appeal. You have the right to a fair hearing.
You have the right to a face-to-face hearing, if you ask for one. You can indicate this on the Appeal and Request for Hearing form when you file an appeal.
Due to budget constraints, the number of face-to-face hearings is limited. The issue of your appeal will be used to determine if a face-to-face hearing will be granted.
If your appeal has already been scheduled as a telephone hearing, you will need to write to the Administrative Law Judge and tell the judge that you would prefer to have an in person hearing, rather than a telephone hearing. The judge's name and address is on the Notice of Hearing.
Your written request must be made at least five working days before the hearing. If you get an in-person hearing, you will get a new Notice of Hearing.
Your lawyer may participate in the hearing with you, but you are not required to have an attorney. You are allowed to attend your appeal hearing without legal representation.
If you do have an attorney, write your lawyer's name on the Appeal and Request for Hearing form or call Appeals at 1-888-723-9637.
You will need to tell HHS Appeals the name and address of your lawyer. Your attorney will receive a copy of everything that you get, including the Notice of Hearing, the Proposed Decision and the Final Decision.
If your hearing will be at the local HHS office, a Child Support Recovery Office, or an in-person hearing, it is suggested that you do not bring your children to the hearing. Even though the appeal hearing is informal, the children may cause a disruption as it is hard to determine how long an appeal hearing will take. It would be best to try to find child care for your children during the appeal hearing.
Even if you are participating from your own home over the telephone, it may be difficult to concentrate on the appeal hearing if there are distractions in the background.
If you can't make it to your appeal hearing, you will need to contact the Administrative Law Judge. You must call the judge before the date and time of your appeal hearing. The judge's name and phone number is on the Notice of Hearing. You will need to explain why you will be unable to make it to the hearing and request that the hearing be rescheduled. You must have a good reason for not attending.
If you do not call the Administrative Law Judge, your appeal will likely be considered abandoned and you will lose your right to a hearing on the action you appealed. A Proposed Decision will be sent out indicating that you have abandoned your appeal hearing.
An appeal hearing is informal and will be digitally recorded. You will be able to participate in the hearing from any location.
The Administrative Law Judge starts the hearing by entering the conference call and determining who is on the line. The judge will write down the names of people who are attending the hearing.
The judge will explain the procedure during the appeal hearing, then swear in individuals who will be participating in the hearing. The Department will give their testimony first and submit exhibits into evidence. Once the Department is finished, you will have a chance to ask the Department questions about their testimony.
Now, it is your turn to testify. If you submitted any supporting documentation, the Administrative Law Judge will assign each piece an exhibit number. Arrangements may be made during the hearing to determine how you will submit copies of the exhibits to the judge, if additional information is needed based on the testimony. It will be up to the judge whether or not to accept exhibits into the record. After you have completed your testimony, the Department will have a chance to ask you questions.
Once questions are over, the judge asks if there were any other comments that either you or the Department would like to make. If not, the hearing is ended.
The Administrative Law Judge will make a decision about your appeal and issue a proposed decision. A decision will not be given during the hearing.
If you missed your appeal hearing and didn't call into the telephone conferencing system on the date and time of your hearing, your appeal is considered abandoned. The administrative law judge will issue a proposed decision dismissing your appeal because you did not attend.
If you believe you had good cause for missing your appeal hearing, you may ask to schedule a new hearing by filingg a motion to vacate.
Your motion to vacate must be sent to the Department by mail, personal delivery, fax or email to:
Iowa Department of Health and Human Services
1305 E. Walnut St, 5th Floor
Des Moines, IA 50319
A motion to vacate must be sent within fourteen days after the date of this decision and state all facts that establish good cause for your failure to appear or participate in the hearing.
Your appeal file will be sent back to an Administrative Law Judge to determine if you had good cause. If you did, a new appeal hearing will be scheduled for you. If you did not, another proposed decision will be issued indicating that you did not have good cause.
Once the Administrative Law Judge has made a decision on your appeal, a Proposed Decision will be issued. It will explain the issue of the appeal, a brief summary of the testimony given during the hearing, and the judge's decision.
If you disagree with the Proposed Decision, you may request a review. Any party, including the Department, may request a review if the party disagrees with the Administrative Law Judge's decision.
A review request must be submitted in writing. Mail, fax or email your request for review to:
Department of Health and Human Services
1305 E Walnut St, 5th Floor
Des Moines, IA 50319
Your request must be postmarked, faxed or emailed within 14 calendar days of the date on the Proposed Decision. The date is located just above the Administrative Law Judge's signature.
If you requested a review and disagree with the Final Decision, you may file a petition in district court in the county you live in. You must file your petition within 30 days of the date on the Final Decision.