Wisconsin Medicaid Fair Hearing: How to Appeal an MSP Denial
The 45-Day Deadline
When your county Income Maintenance consortium denies an MSP application, terminates coverage, or reduces your program tier, the Notice of Decision includes an appeal deadline. You have 45 calendar days from the date on that notice to request a State Fair Hearing. Miss it and you lose the right to challenge that specific decision.
The hearing is adjudicated by the Division of Hearings and Appeals (DHA) within the Wisconsin Department of Administration — an independent body separate from the DHS and the consortium that made the original decision. An Administrative Law Judge reviews the evidence and issues a binding decision.
How to File
You can file your hearing request using:
- Form DHA-28 (Request for Fair Hearing) or Form F-10151 / Form F-00236
- A signed written letter describing what you're contesting
Submit by mail, fax, or email:
Division of Hearings and Appeals P.O. Box 7875, Madison, WI 53707-7875 Fax: (608) 264-9885 Email: [email protected]
The request doesn't need to be on an official form. A signed letter explaining what decision you're appealing and why you believe it's wrong will trigger the process.
Aid Paid Pending: Keep Benefits During the Appeal
If your parent already has MSP coverage and receives a notice of termination or tier reduction, they can request aid paid pending (continuation of benefits). The key: the hearing request must be filed before the effective date of the adverse action — typically within 10 to 15 days of the notice date, not the full 45-day window.
When aid paid pending is granted, the state must maintain your parent's MSP benefits at the current level while the appeal is processed. The Part B premium continues to be paid, QMB cost-sharing protection stays in place, and nothing changes until the hearing decision is issued.
Warning: If the Administrative Law Judge rules against your parent, Wisconsin can recover the cost of premiums paid on the member's behalf during the appeal period as an overpayment. This risk should factor into the decision to request continuation of benefits, particularly if the income numbers are clearly above the threshold.
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Preparing for the Hearing
You have the right to:
- Inspect the complete case file held by the Income Maintenance agency before the hearing
- Present witnesses and documentary evidence
- Be represented by an attorney or non-attorney advocate
Common grounds for appeal include incorrect income calculations (using net instead of gross, failing to apply the $20 disregard, or miscounting whose income belongs in the financial test group), incorrect asset valuations, or procedural errors in the renewal process.
Free legal help is available through Legal Action of Wisconsin (1-888-278-0633, covers southern and coastal counties) and Wisconsin Judicare (1-715-842-1681, covers northern counties).
When the Decision Was Just a Renewal Lapse
If coverage was lost because the renewal paperwork wasn't returned on time — not because of ineligibility — there's a simpler route. Wisconsin enforces a 90-day reconsideration window: submit the renewal documents within 90 days of the termination date, and the agency must process them as a renewal without requiring a new application and reinstate coverage retroactively if the person still qualifies.
Check whether the termination was procedural and whether the 90-day reconsideration window applies before filing a hearing request.
Our Wisconsin Medicare Savings guide includes the hearing preparation checklist and sample evidence statements, plus the 90-day reconsideration steps for procedural lapses.
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Download the Wisconsin — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.