Louisiana Medicaid Fair Hearing — Medicare Savings Appeals
When to Appeal
You have the right to a state fair hearing whenever LDH denies your Medicare Savings Program application, terminates your existing coverage, or reduces your benefit tier (dropping you from QMB to SLMB, for example). LDH must send a written notice explaining the specific reason, citing the Medicaid Eligibility Manual section that supports the decision.
Common denial reasons that are worth appealing:
- Asset-based denial for QMB, SLMB, or QI: Louisiana eliminated the asset test for these programs. A denial citing excess resources is a policy error.
- Income miscalculation: LDH didn't apply the $20 general income disregard, counted income from a non-applicant household member (like an adult child), or used the wrong gross Social Security figure.
- Missing documents: LDH says they didn't receive verification you submitted. If you faxed or uploaded documents, you may have confirmation records.
- Closure for non-response: You didn't receive the renewal form because of an address issue.
Two Deadlines That Matter
30 days for a standard appeal. Louisiana's Division of Administrative Law says applicants and recipients typically must request a fair hearing within 30 days of the date on the LDH decision notice. Check your notice for the exact deadline. Your MSP benefits will change as stated in the notice while the appeal is processed.
10 days for benefit continuation. If you're already receiving MSP benefits and LDH sends a termination or reduction notice, request your hearing within 10 calendar days of the notice date and before the effective date of the action to preserve your current benefits until the hearing is decided. This is called Aid-Paid-Pending.
The 10-day window is critical. If you miss it and coverage ends, SSA resumes the Part B premium deduction, QMB balance billing protection ends, and your deemed Extra Help status ends, so prescription copays rise. Even if you win the appeal months later, the gap can cause real financial damage.
One risk of benefit continuation: if the administrative law judge ultimately upholds LDH's decision, the state can seek recovery of benefits paid during the Aid-Paid-Pending period.
How to File
The Division of Administrative Law — Health and Hospitals Section handles all Medicaid fair hearings. You can file through four channels:
Online: The DAL e-filing portal at laserfiche.adminlaw.state.la.us
Mail: Division of Administrative Law, HH Section, P.O. Box 4189, Baton Rouge, LA 70821-4189
Fax: (225) 219-9823
Phone (oral appeal): (225) 342-5800 or (225) 342-0443
Your request should include your name, Medicaid case number, a copy of the LDH notice you're appealing, and a brief explanation of why you disagree with the decision. Reference specific Medicaid Eligibility Manual sections if you can — for example, Chart Z-900 for the asset waiver, or Section H-1100 for QMB income calculation rules.
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What Happens at the Hearing
Hearings are conducted primarily by telephone conference before an Administrative Law Judge. You can represent yourself or have someone represent you — a family member, an advocate, or an attorney. You'll have the chance to present documents, explain your situation, and respond to LDH's stated reasons for the decision.
For an asset-based QMB denial, the hearing is straightforward: you cite Chart Z-900 and Policy Section I-1630, which codify the asset waiver. The burden shifts to LDH to explain why they applied a test the policy says doesn't exist for MSP applications.
Income disputes are more detailed. Bring your Social Security award letter (showing gross benefit), any pension or VA award letters, pay stubs if you work, and a written calculation showing how the $20 disregard and any earned income disregards bring your countable income below the limit.
Free Legal Help
Regional legal aid organizations across Louisiana can represent you at no cost if you meet their income eligibility requirements:
- Southeast Louisiana Legal Services (SLLS) — serves the New Orleans, Baton Rouge, and eastern Louisiana areas
- Acadiana Legal Service Corporation (ALSC) — serves Lafayette and the Acadiana region, plus other parishes
These organizations handle Medicaid hearing representation regularly. They're most likely to take cases involving clear policy errors (like asset denials) or terminations where continuation benefits are at risk. Contact them as soon as you decide to appeal — they have their own caseload limits.
Louisiana SHIIP (1-800-259-5300) can also help you understand the denial notice and your appeal options, even if they don't represent you at the hearing.
The Louisiana Medicare Savings Programs & Extra Help Guide includes a fair hearing filing checklist, the contact information for all filing channels, and guidance on preparing your case documentation.
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