FAIR HEARINGS

You may appeal to the state Division of Hearings and Appeals or your local county/tribal social or human services department if you believe your:

• Application for Virginia Medicaid was unfairly denied.

• Application was not acted upon promptly.

• Benefits were unfairly discontinued, terminated, suspended, or reduced.

• A prior authorization request was denied.

This appeal may result in a fair hearing.

A fair hearing is a formal meeting held with you, an impartial state administrative law judge and a representative from the agency. At this meeting, all parties review the facts of the case for the state administrative law judge. You may have someone represent you if you choose to do so.

The state administrative law judge will issue a written decision based on the facts of the case and federal and state laws and regulations. Both you and the agency representative will receive a copy of this decision in the mail.