Michigan Medicaid Fair Hearing: How to Appeal a Denial Through MOAHR

When MDHHS Says No — and What You Can Do About It

Your parent applied for long-term care Medicaid or the MI Choice Waiver. The letter from MDHHS came back: denied. Maybe the caseworker counted an asset as non-exempt when it should have been excluded. Maybe the income calculation included a one-time payment that inflated the monthly figure. Maybe the Level of Care Determination came back below the nursing facility threshold.

Whatever the reason, a Medicaid denial in Michigan isn't final. Every applicant has the right to request an administrative fair hearing before the Michigan Office of Administrative Hearings and Rules (MOAHR), where an administrative law judge reviews the agency's decision against MDHHS policy and the evidence.

Most families don't file. The denial letter is discouraging, the process sounds intimidating, and the assumption is that the state has already made up its mind. That assumption costs families coverage they're legally entitled to.

How to Request a Fair Hearing

The process is simpler than it sounds:

Deadline: The hearing request must be received by MOAHR within 90 days of the adverse decision. For an existing Medicaid beneficiary appealing a termination of services, Medicaid must continue to pay during the administrative hearing process when the appeal is filed within the applicable program timeline.

How to file: Complete the "Request for an Administrative Hearing" form (DCH-0092) and submit it to MOAHR. You can:

• Mail the request to: Michigan Office of Administrative Hearings and Rules, P.O. Box 30763, Lansing, MI 48909
• Fax to: 517-763-0146

Include the benefit or issue, [parent's name], case number, the date of the adverse decision, your contact information, and your relationship to the applicant.

What Happens at the Hearing

The administrative hearing is a fact-finding proceeding, not a courtroom trial. Here's what to expect:

Scheduling: MOAHR will send a written notice with the date, time, and location. Hearings may be conducted by phone or video, especially for long-term care cases.

Participants: You (or the applicant), the MDHHS caseworker or representative who made the determination, and the administrative law judge. You don't need a lawyer, though you can bring one or bring an advocate (legal aid organizations in Michigan handle Medicaid hearings regularly).

Evidence: Bring everything relevant to the determination being challenged:

• The denial notice itself
• The Medicaid application and all supporting documents you submitted
• Bank statements, asset documentation, or income records that counter the denial reason
• Medical records if the denial was based on the Level of Care Determination
• Any correspondence with the MDHHS caseworker

The judge's role: The ALJ reviews the caseworker's determination against MDHHS policy (the Bridges Eligibility Manual, or BEM) and the evidence presented. The judge can uphold the denial, reverse it, or send it back to the caseworker for reconsideration with specific instructions.

Issues to Examine in a Denial

These are examples of issues to examine:

Asset miscalculation — The caseworker counted an exempt asset as countable. Common mistakes: counting the primary vehicle (one vehicle is fully exempt in Michigan regardless of value), counting household goods or personal effects, counting a properly structured irrevocable prepaid funeral contract, or counting the primary residence when the applicant or their spouse has a stated intent to return.

Income over-counting — Check whether a one-time lump sum (inheritance, insurance settlement, back pay) was classified under the correct income rules and whether the spousal impoverishment income allowance was applied correctly — the community spouse is entitled to a Minimum Monthly Maintenance Needs Allowance of $2,705/month effective July 1, 2026.

Level of Care Determination errors — The LOCD assessment understated the applicant's functional limitations. If your parent needs hands-on physical assistance with multiple Activities of Daily Living and the assessment recorded "supervision only," bring medical records documenting the actual care needs. Physician statements and hospital discharge summaries carry weight.

Procedural errors — MDHHS failed to send required notices or failed to consider all submitted documentation. Check the applicable processing deadline for the program and application type.

Michigan Legal Aid Resources for Medicaid Hearings

You don't need to navigate this alone:

• Michigan Legal Services (statewide): 800-388-6043 — free legal representation for low-income seniors in Medicaid hearings
• Legal Aid of Western Michigan: 888-783-8190
• Lakeshore Legal Aid (southeast Michigan): 888-783-8190
• Center for Civil Justice (Saginaw/Bay City area): 989-755-3120

These organizations handle Medicaid eligibility disputes regularly and can tell you within one intake call whether your parent's denial has grounds for reversal.

Connecting the Hearing to the Bigger Plan

A Medicaid denial doesn't just block one program — it can stall the entire post-hospital care plan. If your parent is transitioning from a hospital or SNF and Medicaid eligibility is in question, the Hospital-to-Home Michigan toolkit walks through the financial eligibility thresholds, asset protection strategies, and application sequence so the first application has the strongest possible chance of approval — reducing the need for a hearing in the first place.

See more Michigan guides →