Maryland Fair Hearing for Medicare Savings Program Denials and Terminations
When to File a Fair Hearing
Maryland beneficiaries have the right to a fair hearing whenever a Medicare Savings Program application is denied, coverage is terminated, or the state fails to process an application within the 45-day federal time limit. The hearing is conducted by the Maryland Office of Administrative Hearings (OAH), not by the local DSS that made the decision.
Common situations that warrant an appeal:
- Denial for income or assets when you believe the caseworker miscounted — particularly around the $20 disregard, the earned income exclusion, or exempt resources like burial funds
- Termination at renewal based on an income increase that doesn't actually push your parent above the limit
- Procedural closure because the local DSS claims documents weren't received (when you have proof they were)
- Processing delay beyond the 45-day federal standard with no decision issued
Two Critical Deadlines
Maryland's appeal process has two separate deadlines that serve completely different purposes. Confusing them can cost your parent months of coverage.
90 days to request a fair hearing. The appeal must be filed within 90 calendar days of the date on the denial or termination notice. This is the outer boundary — miss it and the right to appeal that specific decision expires.
10 days for aid paid pending. If your parent is already receiving MSP benefits and the state is terminating or reducing them, filing the appeal within 10 calendar days of the notice's mailing date (check the postmark) triggers "aid paid pending." This means coverage continues at the current level throughout the entire appeal process — the state cannot cut off the benefit while the hearing is pending.
The 10-day window is unforgiving. Day 11 means your parent loses coverage during the appeal even if they ultimately win. If the notice arrives on a Friday and you see it Monday, the clock is already running.
For new applications that were denied (your parent wasn't receiving benefits yet), aid paid pending doesn't apply — there's nothing to continue. But the 90-day window still governs the appeal filing.
How to File
Send a written request for a fair hearing to the Maryland Department of Health or the Office of Administrative Hearings. The request should include:
- Your parent's name, case number, and date of birth
- The date of the notice being appealed
- A clear statement of what's being appealed (denial, termination, or processing delay)
- The reason you believe the decision is wrong
If filing within the 10-day window, explicitly state that you are requesting aid paid pending under federal Medicaid regulations.
Keep a copy of the request and send it by certified mail or get a receipt if delivering in person. The filing date is what matters, and you need proof of when it was submitted.
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What Happens at the Hearing
The OAH assigns an administrative law judge to hear the case. Both sides present evidence — the local DSS explains why they denied or terminated benefits, and your parent (or their representative) explains why the decision is wrong.
Bring documentation: bank statements, Social Security award letters, pension statements, the eligibility worksheet showing how income was calculated, and any correspondence with the local DSS. If the dispute is about a resource that should be exempt (a burial fund, a primary residence), bring proof of the exemption.
Legal representation is not required but can help, especially for complex income-counting disputes. Maryland Legal Aid and the Maryland Senior Legal Helpline provide free representation for low-income seniors in Medicaid administrative hearings.
If Your Parent Wins
The OAH issues a decision, and the local DSS must implement it. If coverage was terminated and the appeal is successful, benefits are restored retroactively. The Part B premium refund process restarts for the period that was lost.
If aid paid pending was in effect, coverage was never actually interrupted — the decision simply confirms it continues.
The Maryland Medicare Savings Programs, Extra Help & SPDAP Guide includes the appeal timeline, a sample hearing request letter, and a checklist of evidence to prepare for an OAH hearing.
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Download the Maryland — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.