Washington Medicare Savings Program Denied: How to Appeal a DSHS Decision

A Denial Doesn't Mean You're Ineligible

MSP denials in Washington often stem from administrative errors, not actual ineligibility. Families apply on the wrong portal, DSHS miscalculates income by missing the $20 disregard, or the automated system pulls outdated income data. Before accepting a denial, look at the reason code on the notice.

The denial letter (Notice of Action) cites the specific WAC rule, shows the countable income calculation DSHS used, and states your hearing rights. That calculation is where mistakes hide.

Common Denial Reasons Worth Challenging

Wrong portal submission. Submitting an MSP application through Washington Healthplanfinder for a Medicare-entitled person results in processing delays or administrative rejection. Use Washington Connection or Form HCA 13-691.

Income counted wrong. DSHS sometimes uses gross income without applying the $20 general unearned income disregard, or counts a non-applying spouse's full income without the proper spousal allocation. Pull out the denial letter's income calculation and compare it against the rules in WAC 182-517-0100.

Missing verification documents. If DSHS sent a Request for Information and the deadline passed without a response, the application gets denied for failure to verify. You can reapply immediately — there's no waiting period.

Asset confusion. Although Washington eliminated the asset test for MSPs, some applicants get screened out at the multi-program application level because the general form evaluates assets for other benefits. This should never block MSP approval, but data entry errors happen.

How to Request a Fair Hearing

You have 90 calendar days from the date DSHS/HCA mailed the denial notice to request a fair hearing with the Office of Administrative Hearings (OAH). If the decision terminates existing benefits, you can preserve them during the hearing under "aid paid pending" by requesting a hearing within 10 calendar days of the notice date or before the adverse action takes effect.

To request a hearing:

• Written request: Mail it to the Office of Administrative Hearings, PO Box 42488, Olympia, WA 98504-2488, or deliver it to a local DSHS Community Services Office
• Phone: Call DSHS at 1-877-501-2233 or OAH at 1-800-583-8271

The hearing is conducted by an Administrative Law Judge (ALJ). You can participate in person, by phone, or by video. You don't need a lawyer, but if the case involves complex income calculations or repeated denials, contact the Northwest Justice Project (NJP) at 1-888-201-1014 for free legal help.

What to Bring to a Hearing

Gather everything that supports your income calculation:

• Your Social Security benefit statement (SSA-1099 or monthly benefit letter)
• Private pension or annuity statements
• Pay stubs if you or your spouse have earned income
• The denial notice with DSHS's income calculation
• Your own calculation showing countable income after applying the $20 disregard and any earned income exclusions

The ALJ reviews DSHS's calculation against the evidence you present. If DSHS made an error, the judge orders them to process the application correctly.

When to Reapply Instead of Appeal

If the problem was an incorrect submission or missing verification, you can submit a new application with the corrected information. You still have 90 calendar days from the date the denial notice was mailed to request a hearing about that decision.

For denial letter templates, income worksheets, and a hearing preparation checklist, see the Washington Medicare Savings Programs & Extra Help Guide.

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