Utah Medicaid Fair Hearing: How to Appeal a DWS Denial

When You Have Grounds for a Fair Hearing

If the Department of Workforce Services (DWS) denies your parent's long-term care Medicaid application, reduces their benefits, or calculates a spend-down amount you believe is wrong, you have the legal right to challenge that decision through a fair hearing. This isn't a suggestion box — it's a formal administrative proceeding where a judge reviews whether DWS correctly applied eligibility rules to your case.

Common situations that warrant an appeal include denial for excess assets when you believe certain assets are exempt, a transfer penalty calculation you think is incorrect, a spend-down amount that doesn't account for legitimate medical expenses, or termination of benefits at annual renewal.

The 90-Day Deadline

You must request a fair hearing within 90 days of the date on the DWS notice of action. Not 90 days from when you received the letter — 90 days from the date printed on it. If you miss this window, you lose your appeal rights for that specific decision.

File the request using Form 490, available from the DWS Appeals Division. You can submit by mail, fax, or in person. Include the case number from your denial notice, a clear statement of what you're disputing, and any supporting documentation DWS may not have considered.

Continuing Benefits During the Appeal

If your parent was already receiving Medicaid and DWS is reducing or terminating benefits, ask DWS whether a fair-hearing request filed before the effective date can keep benefits running at the current level while the appeal is pending. The notice will state the applicable cut-off date.

For initial application denials, there are no continuing benefits to protect, but a timely appeal lets you challenge the decision.

What Happens at the Hearing

A hearing examiner from the DWS Division of Adjudications (or, for disability-related appeals, the DHHS Office of Administrative Hearings) reviews your case. The hearing is typically conducted by phone, though you can request an in-person hearing.

You'll have the opportunity to present evidence, explain your position, and respond to DWS's reasoning. The eligibility caseworker who made the original decision may also participate to explain how they applied the rules.

Bring everything relevant: bank statements showing asset values, receipts for spend-down purchases, medical records supporting clinical eligibility, written contracts for caregiver payments, and any correspondence with DWS that shows inconsistencies in how your case was handled.

You can bring an attorney or representative, but it's not required. For straightforward factual disputes — like whether a specific asset is countable or exempt — families often handle the hearing successfully on their own.

After the Decision

The hearing examiner issues a written decision. If you win or lose, follow the decision's instructions and consult an elder law attorney about any further review options.

Our Utah Medicaid Long-Term Care & Asset Protection Guide covers the documentation requirements and eligibility rules that prevent most denials in the first place — reducing the chance you'll need to go through the appeals process at all.

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