(a) The Medicaid agency must be responsible for maintaining a hearing system that meets the requirements of this subpart.
(b) The State's hearing system must provide for—
(1) A hearing before—
(i) The Medicaid agency; or
(ii) For the denial of eligibility for individuals whose income eligibility is determined based on the applicable modified adjusted gross income standard described in§ 435.911(c) of this chapter, the Exchange or Exchange appeals entity to which authority to conduct fair hearings has been delegated under § 431.10(c)(1)(ii), provided that individuals who have requested a fair hearing are given the choice to have their fair hearing conducted instead by the Medicaid agency; at state option the Exchange or Exchange appeals entity decision may be subject to review by the Medicaid agency in accordance with § 431.10(c)(3)(iii); or
(2) An evidentiary hearing at the local level, with a right of appeal to the Medicaid agency.
(c) The agency may offer local hearings in some political subdivisions and not in others.
(d) The hearing system must meet the due process standards set forth in Goldberg v. Kelly, 397 U.S. 254 (1970), and any additional standards specified in this subpart.
(e) The hearing system must be accessible to persons who are limited English proficient and persons who have disabilities, consistent with § 435.905(b) of this chapter.
(f) The hearing system must comply with the United States Constitution, the Social Security Act, title VI of the Civil Rights Act of 1964, section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, and section 1557 of the Affordable Care Act and implementing regulations.
[44 FR 17932, Mar. 29, 1979, as amended at 78 FR 42301, July 15, 2013; 81 FR 86448, Nov. 30, 2016]
Notes of Decisions
Shakhnes Ex Rel. Shakhnes v. Berlin, 689 F.3d 244 (2d Cir. 2012).
· cites it 2× “Law § 364 (2)(h), and for ensuring the fair hearing system’s compliance with federal law and regulations, see 42 C.F.R. § 431.205 . II. The Instant Matter.”
Fishman v. Daines, 743 F. Supp. 2d 127 (E.D.N.Y 2010).
· cites it 4× “) *134 Among other things, the applicable federal regulations allow a state to dismiss a Medicaid appeal if the appellant “ ‘fails to appear at a scheduled hearing without good cause.’ ” (Id. ¶ 33 (citing 42 C.”
Strouchler v. Shah, 891 F. Supp. 2d 504 (S.D.N.Y. 2012).
· cites it 4× “See 42 C.F.R. § 431.205 (d); 18 N.Y.C.R.R. § 505.”
Murphy v. Curtis, 930 N.E.2d 1228 (Ind. Ct. App. 2010).
· cites it 2× “Merits of State's Argument The State claims that the trial court erred in concluding that ALJs are required to consider evidence unrelated to the conditions listed in the application for benefits being reviewed by the ALJ.”
Rosen v. Tennessee Comm'r of Fin. & Admin., 280 F. Supp. 2d 743 (M.D. Tenn. 2002).
· cites it 6× “2, permanently enjoins the defendant “from terminating, reducing or suspending the TennCare coverage of members of the plaintiff class who are enrolled in the TennCare program, without affording such individuals notice and an opportunity for hearing in accordance with 42 C.”
Gomolisky v. Davis, 716 N.E.2d 970 (Ind. Ct. App. 1999).
· cites it 5× “42 C.F.R. § 431.205 (b) states: “The State’s hearing system must provide for — (1) A hearing before the agency; or (2) An evidentiary hearing at the local level, with a right of appeal to a State agency hearing.”
NB Ex Rel. Peacock v. Dist. of Columbia, 794 F.3d 31 (D.C. Cir. 2015).
“It instead more generally calls for the District to establish a system for hearings that conforms to the requirements of due process. The provision thus ultimately adds little to the plaintiffs’ arguments under the Due Process Clause (which we separately consider below).”
Perdue v. Gargano, 964 N.E.2d 825 (Ind. 2012).
“” 42 C.F.R. § 431.205 (d). As such, the plaintiffs' statutory claim under Section 431.”
Albert S. v. Dep't of Health & Mental Hygiene, 891 A.2d 402 (Md. Ct. Spec. App. 2006).
· cites it 2× “42 C.F.R. § 431.205 . Maryland has opted to provide for "[a]n evidentiary hearing at the local level, with a right of appeal to a State agency hearing.”
Dultz v. Velez, 726 F. Supp. 2d 480 (D.N.J. 2010).
· cites it 3× “Under the federal Medicaid regulations, a state’s hearing system must either provide for a "hearing before the agency”, 42 C.F.R. 431.205(b)(1), or "[a]n evidentiary hearing at the local level, with a right of appeal to a State agency hearing.”
— 42 C.F.R. § 431.205(b) — 1 case
— 42 C.F.R. § 431.205(b)(1) — 3 cases
Dultz v. Velez, 726 F. Supp. 2d 480 (D.N.J. 2010).
“Under the federal Medicaid regulations, a state’s hearing system must either provide for a "hearing before the agency”, 42 C.F.R. 431.205(b)(1), or "[a]n evidentiary hearing at the local level, with a right of appeal to a State agency hearing.”
— 42 C.F.R. § 431.205(b)(2) — 1 case
Dultz v. Velez, 726 F. Supp. 2d 480 (D.N.J. 2010).
“Under the federal Medicaid regulations, a state’s hearing system must either provide for a "hearing before the agency”, 42 C.F.R. 431.205(b)(1), or "[a]n evidentiary hearing at the local level, with a right of appeal to a State agency hearing.”
— 42 C.F.R. § 431.205(d) — 7 cases
Fishman v. Daines, 743 F. Supp. 2d 127 (E.D.N.Y 2010).
“) *134 Among other things, the applicable federal regulations allow a state to dismiss a Medicaid appeal if the appellant “ ‘fails to appear at a scheduled hearing without good cause.’ ” (Id. ¶ 33 (citing 42 C.”
Dultz v. Velez, 726 F. Supp. 2d 480 (D.N.J. 2010).
“Under the federal Medicaid regulations, a state’s hearing system must either provide for a "hearing before the agency”, 42 C.F.R. 431.205(b)(1), or "[a]n evidentiary hearing at the local level, with a right of appeal to a State agency hearing.”
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