Georgia Medicaid Fair Hearing for Medicare Savings Programs: How to Appeal a Denial
A DFCS denial or termination notice for your parent's Medicare Savings Program benefits isn't the final word. Georgia law gives every applicant the right to a fair hearing — an independent review by an administrative law judge who isn't part of DFCS.
The Two Deadlines That Matter
30 calendar days from the notice date: the window for filing a written appeal. Miss this and the denial or termination stands.
14 calendar days from the timely adverse notice: the window for requesting continued benefits while the appeal is pending. If your parent currently has QMB, SLMB, or QI and DFCS is terminating coverage, filing within 14 days keeps the benefits running through the hearing decision. Filing between day 15 and day 30 preserves the right to appeal but doesn't maintain benefits during the process.
The risk with continued benefits: if the ALJ upholds DFCS's decision, DCH can seek recovery of premiums paid during the continuation period.
How to File
Submit a written hearing request to the county DFCS office where your parent's case is held, or to the county's Fair Hearing Coordinator. The request doesn't need to be on a specific form — a clear written statement identifying the adverse action and requesting a hearing satisfies the requirement. Some families use Form 508, but any written request works.
Verbal complaints to caseworkers don't count. They don't extend the 30-day deadline and they don't trigger the appeal process.
What Happens After Filing
DFCS 3-day internal review. Within 3 business days of receiving the appeal, DFCS conducts an internal review under PAMMS Appendix B. If they find their own error — a miscalculated income, a missed disregard, a wrongly counted asset — they fix it immediately and the appeal stops there.
Transfer to OSAH. If DFCS sustains the action, they submit Form OSAH-1 (State Agency Referral Form) to the Georgia Office of State Administrative Hearings. OSAH is an independent state tribunal — it's not part of DFCS or DCH.
The hearing. An Administrative Law Judge conducts an evidentiary hearing by phone, video, or in person. Your parent can present documents, bring witnesses, and cross-examine DFCS staff who made the eligibility determination. The ALJ evaluates whether DFCS correctly applied the published income standards, disregards, and resource rules.
The decision. The ALJ must issue a written decision with findings of fact and conclusions of law within 90 days of the initial hearing request.
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When Fair Hearings Win
The most common grounds for overturning DFCS denials in MSP cases:
- The caseworker failed to apply the $20 unearned income disregard
- Income from an excluded source (VA Aid and Attendance, burial fund interest) was incorrectly counted
- A retirement account in payout was counted as a lump-sum resource instead of excluding the principal
- The COLA disregard wasn't applied during the January-April gap period
- Electronic verification data was stale or matched the wrong individual
Free Legal Help
Your parent can represent themselves, designate an authorized representative, or get free legal counsel:
- Atlanta Legal Aid Society covers Fulton, DeKalb, Cobb, Gwinnett, and Clayton counties
- Georgia Legal Services Program (GLSP) serves the remaining 154 counties
Both organizations prioritize fair hearing representation for low-income seniors facing benefit terminations. Contact them as early as possible — high caseloads mean availability is limited.
If the ALJ rules against your parent and the decision appears to misapply the law, a petition for judicial review can be filed in the Superior Court of Fulton County or your parent's county of residence within 30 days.
The Georgia Medicare Savings Programs & Extra Help Guide includes a fair hearing preparation checklist, a timeline tracker for appeal deadlines, and the specific PAMMS manual sections to cite when building a case.
Get Your Free Georgia — Medicare Savings Program Eligibility Checklist
Download the Georgia — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.