Texas Medicare Savings Program Denied — How to Appeal Through a Fair Hearing
Check the Denial Notice First
When HHSC denies an MSP application or terminates existing benefits, they send Form H1009 (Notice of Eligibility/Action). This notice details the specific reason for the decision — usually an income or asset calculation — along with the income figures HHSC used and the appeal deadline.
Read the income calculation line by line. Common errors include: failing to apply the $20 monthly income disregard, counting an excluded asset (like the primary home or one vehicle), double-counting spousal income when spouses live separately, or applying the January COLA increase during the January–March disregard period.
You Have 90 Days to Request a Fair Hearing
Under Title 1, Part 15, Chapter 357 of the Texas Administrative Code, your parent (or their authorized representative) has 90 calendar days from the date on the Form H1009 notice to request a Fair Hearing. Three ways to file:
- Online through YourTexasBenefits.com
- By phone by calling 2-1-1 and recording an oral appeal request
- In writing by mailing or hand-delivering a written appeal statement to any HHSC benefits office
You don't need a lawyer to request a hearing, and you don't need to use a specific form. A clear written statement identifying the case, the decision being appealed, and why you believe the decision is wrong is sufficient.
The 13-Day Window for Continued Benefits
This is the deadline that matters most when an existing MSP recipient faces benefit termination: if your parent requests a Fair Hearing within 13 calendar days from the date the adverse notice was mailed (or before the effective date of the proposed termination), HHSC must maintain the existing MSP coverage while the appeal is pending.
Miss that 13-day window and the benefit stops during the appeal. Your parent may still win the hearing, but they'll have a gap in coverage that can mean months of paying the Part B premium out of pocket and losing QMB billing protections.
If HHSC upholds the termination at the hearing, the agency can seek recoupment of benefits paid during the appeal period.
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What Happens at the Hearing
The Fair Hearing is an administrative proceeding, not a courtroom trial. HHSC must issue a decision within 90 days of the appeal request date. Hearings are typically conducted by phone, though in-person hearings at a local HHSC office can be arranged.
Bring documentation that supports your case: the Form H1009 notice, current income statements (SSA-1099 or recent COLA letter), bank statements showing countable assets below the limit, and any documents showing HHSC made a calculation error. If the denial involved the COLA disregard or an asset exclusion, bring the specific figures.
Common Denial Reasons and What to Challenge
Income barely over the limit: Check whether HHSC applied the $20 disregard. Check whether the caseworker used gross income instead of countable income. If your parent's income increased due to the January COLA, check whether the disregard was applied (January through March).
Assets over the limit: Verify that the home, vehicle, burial funds ($1,500), and personal belongings were properly excluded. If a joint bank account was counted in full, provide deposit records showing the co-holder's contributions.
Procedural denial (missing documents): If HHSC denies an initial application after a Form H1020 deadline, follow the notice on how to appeal or reapply. The 90-day re-evaluation without a new application applies to a missed renewal packet: submit the renewal materials within 90 days of closure.
Free Legal Help
If the case is complex — disputed asset valuations, spousal income deeming, or an existing QMB recipient facing termination — Texas Legal Services Center (1-800-252-3342) and Lone Star Legal Aid provide free legal representation for Fair Hearings.
Our Texas Medicare Savings Programs & Extra Help Guide covers the full appeal timeline, specific language for the hearing request, and a worksheet for checking HHSC's income and asset calculations against your own documentation.
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