West Virginia Medicare Savings Program Denied? How to Appeal
Your Right to a Fair Hearing
If the West Virginia Department of Human Services denies your Medicare Savings Program application or terminates existing coverage, you have the right to an administrative fair hearing. These hearings are conducted by the West Virginia Office of Inspector General (OIG) Board of Review — an independent body separate from DoHS.
The denial notice itself is your starting point. It should state the reason for the decision, the policy basis, and your appeal rights. Read it carefully — some denials result from missing documents rather than actual ineligibility, and those are fixable without a hearing.
The Two Deadlines That Matter
90 days — You have 90 calendar days from the mail date on the DoHS Notice of Decision to request a fair hearing by filing Form IG-BR-29.
10 to 13 days — To keep your MSP benefits active during the appeal (called "aid paid pending"), you must file Form IG-BR-29 within 10 to 13 calendar days of the notice date. Miss this shorter window and your benefits stop while the appeal is pending.
Aid paid pending is critical for QMB enrollees. Without it, you lose billing protections and start owing deductibles and copays for every Medicare service while the appeal grinds through. If the hearing officer ultimately upholds the denial, DoHS can establish a repayment claim for benefits paid during the appeal period — but many families consider that risk worth taking to maintain coverage during the process.
How to File
Send Form IG-BR-29 to:
West Virginia Office of Inspector General Board of Review 1900 Kanawha Boulevard East, Building 6, Suite 817 Charleston, WV 25305
Phone: 304-352-0805 Email: [email protected]
The form is straightforward — your identifying information, the decision you're contesting, and a brief statement of why you believe the decision is wrong. Include a copy of the denial notice.
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Everything in this article as a printable checklist — plus action plans and reference guides you can start using today.
Common Reasons for Denial (and How to Respond)
Missing documents: DoHS requested verification you didn't submit in time. If you have the documents now, ask about the 90-day reconsideration grace period — your case may be reopened without a full appeal if you submit everything within 90 days of termination.
Income counted incorrectly: Caseworkers sometimes count net income instead of applying the $20 general disregard, or count an adult child's income toward a parent's case. Non-MAGI rules exclude adult children entirely. Bring documentation showing gross income and the correct disregard calculation.
Outdated resource limits applied: If the denial cites resource limits of $4,000/$6,000, those are legacy figures. The 2026 federal limits are $9,950/$14,910, and they supersede state publications.
Spouse's income incorrectly included: If spouses are legally separated or living apart with no shared finances, each person should be evaluated individually. The denial notice should show which figures were used — compare them against your actual household structure.
Free Legal Help
Legal Aid of West Virginia provides free legal representation for low-income seniors facing wrongful benefit denials or terminations. Call 1-866-255-4370 to request intake. They handle administrative fair hearings and can represent you before the OIG Board of Review at no cost.
WV SHIP (State Health Insurance Assistance Program) can also help you understand the denial and prepare for an appeal. Call 1-877-987-4463 for free, unbiased Medicare counseling.
After the Hearing
The hearing officer issues a written decision. If the decision overturns the denial, review it for instructions and the effective date for restoring benefits.
If the hearing officer upholds the denial and you believe the decision was legally wrong, contact Legal Aid of West Virginia to discuss next steps.
The West Virginia Medicare Savings Programs guide includes a step-by-step appeal workflow, the IG-BR-29 filing instructions, and a checklist of evidence to gather before your hearing.
Get Your Free West Virginia — Medicare Savings Program Eligibility Checklist
Download the West Virginia — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.