LOOKING FOR INFORMATION
Office of Fair Hearings – FAQ
About Us:
The Office of Fair Hearings (OFH) provides administrative hearings consistent with state (NMAC) and federal regulations (CFR). The OFH registers appeals of adverse actions across all public assistance categories as well as Child Support enforcement actions, Managed Care Organization actions, certain actions involving nursing home care as well as certain administrative actions concerning providers. Hearings are conducted by an Administrative Law Judge and typically held telephonically. After most hearings, a Recommendation will be submitted to the appropriate Division Director who will issue the Final Decision (the OFH issues a Final Decision for BeWellNM and Child Support enforcement appeals as well as Administrative Disqualification Hearings).
1. Q: What is a Fair Hearing?
A: A Fair Hearing is an administrative challenge to an adverse action taken by the HCA. The hearing is conducted by an Administrative Law Judge who was not involved in the action taken. “Adverse actions” may include a denial, closure, reduction, sanction or delay of benefits. During the hearing, you and the HCA will present your case as to why the action was correct or incorrect. Each party has the right to submit evidence, call witnesses and ask questions of the other party.
2. Q: Who can request a hearing?
A: Any applicant or beneficiary can request a Fair Hearing. Fair Hearings can also be requested by an attorney, guardian or an authorized representative. If requesting a hearing for someone else, you may be asked to provide proof of your authority to act on behalf of that individual.
3. Q: How long do I have to file my appeal:
A: Most appeals must be requested no later than 90 days from the date the action was taken by the HCA or its agent.
4. Q: Can I continue to receive my benefits during the appeal process?
A: You may be able to continue receiving your benefits at the prior level. The OFH does not administer benefits and this determination is made through the Income Support Division or the Medical Assistance Division. You do not have to continue receiving benefits during your appeal. If you do continue your benefits during the appeal, you may have to pay back any benefits issued to you if you lose your appeal.
5. Q: Do I need an attorney?
A: You have the right to represent yourself, have an attorney represent you or have an authorized representative (i.e. family member, friend, social worker, etc.) represent you. Most people who have hearings at the OFH do not have an attorney. The OFH cannot advise which course of action is best for you and does not endorse or recommend specific attorneys or community resources. You can contact the NM State Bar Association at 505-797-6000 for available legal resources.
6. Q: What will I receive from the OFH?
A: The OFH will send you an Acknowledgement Notice which will tell you your case number and the issue being appealed. You will also receive a Schedule Notice of Hearing which will provide you with the date and time of the hearing as well as the number to call to participate in the hearing.
7. Q: How will my hearing be conducted?
A: Hearings are primarily held telephonically but can be held in-person or on video conference if appropriate. When requesting a hearing, please indicate if you require an accommodation and the accommodation needed so this can be reviewed. You will have 15 minutes from the scheduled start time to appear for your hearing. The OFH does not call you, YOU MUST CALL the number on the Schedule Notice at the date and time of your hearing.
8. Q: My hearing is scheduled for a date and/or time I am not available. How can I get it rescheduled?
A: You can contact the OFH and request that your hearing be rescheduled. Please contact the OFH as soon as you know you will not be able to attend and provide any alternative dates/times for your hearing. Your hearing can be rescheduled one (1) time. Any additional requests for rescheduling will be at the discretion of the ALJ.
9. Q: What should I tell the ALJ and what evidence do I need to submit?
A: The OFH cannot advise you on what to say or what evidence to submit. 8.50.130 NMAC, 8.100.970 NMAC, and 8.352.2 NMAC are the state regulations about the Fair Hearing process.
10. Q: I have evidence I would like the ALJ to review, how do I submit it?
A: You can fax it to (505) 476-6215, email it to HCA-FairHearings@hca.nm.gov, send it via postal mail to Health Care Authority, Attn: Office of Fair Hearings, PO Box 2348, Santa Fe, NM 87504 or you can turn it in at any local ISD office and ask they send it to us via email.
11. Q: Can I have witnesses at my hearing?
A: Yes, you can have witnesses attend your hearing. You will have to provide them with the hearing information. The OFH does not have the authority to subpoena witnesses or documents.
12. Q: When will the decision on my appeal be made?
A: Most hearings will result in the ALJ submitting a Recommendation to the appropriate Division Director, who will then issue the Final Decision. The Final Decision will be sent to the mailing address on file. Unless the appeal is dismissed, a decision WILL NOT be issued at the hearing. Depending on the benefit appealed, most decisions are issued within 60 or 90 days from the date of your appeal request.
13. Q: I disagree with the Final Decision, what should I do next?
A: You have 30 days from the date of the Final Decision to appeal to the NM District Court (NM Court of Appeals if a TANF hearing). The OFH and HCA will not pay for any expenses you may incur as a part of your appeal.
14. Q: The issue with my benefits is resolved, how do I cancel my hearing?
A: Most appeals can be withdrawn verbally over the phone. Appeals involving the DD and Mi Via Waivers, Managed Care Organizations and Child Support actions must be withdrawn in writing. Your written request to withdraw your appeal can be emailed to HCA-FairHearings@hca.nm.gov, faxed to (505) 476-6215, or sent through postal mail to Health Care Authority, Attn: Office of Fair Hearings, PO Box 2348, Santa Fe, NM 87504.
15. Q: What do I do if I missed my hearing.
A: You will have 10 days from the date of the hearing to contact the OFH and provide the reason you missed the hearing. If your reason is determined to be ‘good cause”, the hearing may be rescheduled. “Good cause” is typically defined as a death in the family, disabling illness or other significant emergency or exceptional circumstance.