How To Challenge a Denial of NYC Medicaid

What do you do when Medicaid has been denied? The first thing to do is file a request for a fair hearing. “Fair hearing” means Medicaid court. It’s called “fair hearing” because the Constitution requires a fair hearing before government benefits can be terminated. Do not be mislead by this term – this is an administrative proceeding for which it is essential to be represented by an attorney.

Just being nice to the hearing officer (essentially, a judge) will not help. Quite the opposite – you need an attorney to aggressively argue your case and to present points of law and prior decisions to prove that you qualify for Medicaid.

When arguing before the fair hearing officer, it is essential to establish a record so that if the decision is not in your favor, it can be challenged in an Article 78 proceeding in New York Supreme Court. The Department of Social Services is a New York State entity and follows the law, so winning the fair hearing or the Supreme Court Article 78 procedure will mean qualifying for New York Medicaid.