North Dakota Medicaid Denied: How to Appeal a Medicare Savings Program Decision
The 30-Day Appeal Window
When North Dakota denies a Medicare Savings Program application or terminates existing coverage, the official notice includes the specific regulation cited, the financial figures used in the calculation, and Form SFN 162 (Request for Hearing).
You have 30 calendar days from the date printed on the notice to request a fair hearing. Request it within that period to preserve your appeal rights. Mark the calendar the day the notice arrives.
How to File
Form SFN 162 is attached to every adverse action notice. You can file it by:
- Mailing the completed form to ND HHS
- Submitting online through hhs.nd.gov
- Delivering it in person to any Human Service Zone office
- Calling the Customer Support Center at 1-866-614-6005 and requesting a hearing verbally
Written or verbal — both count. But paper creates a record, and you'll want one.
Keeping Benefits While You Appeal
If you file the hearing request on or before the effective date of the adverse action, MSP benefits continue unchanged while the appeal is pending. This is called "aid paid pending."
The timing matters. The notice states the date coverage will end. File before that date, and your parent keeps QMB, SLMB, or QI coverage throughout the hearing process. File after, and coverage stops while you wait.
One risk: if the hearing officer upholds the state's decision, ND HHS can seek recovery of benefits paid during the appeal period. Weigh this against the cost of losing coverage during the process.
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What the Hearing Looks Like
An Administrative Law Judge (ALJ) from the North Dakota Office of Administrative Hearings conducts the proceeding by teleconference or in person. Your parent can:
- Review the full case file before the hearing
- Present witnesses
- Submit documentary evidence (bank statements, benefit letters, calculations showing the state made an error)
- Bring legal counsel or an authorized representative
Most MSP appeals come down to how income or assets were calculated. Common issues include the state using the wrong Social Security amount, not applying the $20 income disregard correctly, or counting an excluded asset (like a primary home or one vehicle) toward the resource limit.
Free Legal Help
Low-income seniors can get free legal representation through Legal Services of North Dakota (Senior Helpline: 1-800-662-5813). They handle Medicaid and MSP denial hearings and can represent your parent at no cost if income qualifies.
The North Dakota SHIC program (1-888-575-6611) can also help review the denial notice and identify calculation errors, though SHIC counselors can't serve as legal representatives at the hearing itself.
Check the Math First
Before filing an appeal, pull out the denial notice and verify the numbers. Did the state use gross Social Security instead of net? Did they apply the $20 disregard? Did they count an asset that should be excluded?
The North Dakota Medicare Savings Programs & Extra Help Guide includes an eligibility worksheet that mirrors the state's calculation method, so you can check the denial figures against your own numbers before deciding whether to appeal.
Get Your Free North Dakota — Medicare Savings Program Eligibility Checklist
Download the North Dakota — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.