A fair hearing is a chance for you to tell us the reasons you think your child should have a Medicaid service you asked for but did not get. You can ask for a hearing within 90 days of the date of the letter that said you could not get the service. You can ask for a fair hearing by calling your child’s Medicaid medical plan (or dental plan if the problem is with a dental service).
If your child does not have a Medicaid medical plan, call 1-800-727-5436 (toll-free). Pick option 5. If you would like to make your request in writing, please send it to the following address:
Texas Medicaid & Healthcare Partnership (TMHP)
Attention: Medical Affairs Support, MC-A13
PO Box 204270
Austin, TX 78720-4270
After we get your phone call or letter, a hearing officer will send you a letter. The letter will tell you the date and time of the hearing. It also will tell you what you need to know to get ready for the hearing. The hearing can take place by phone or in person.
During the Hearing
You can explain why you asked for the service that your child didn’t get. You can speak for yourself or you can ask someone else to speak for you. This could be a friend, a family member, or a lawyer. The hearing officer will listen to what you have to say. The hearing officer also will listen to the reasons why you were told your child couldn’t get the service. You can ask questions about these reasons. The hearing officer might ask you some questions. A final decision will be made within 90 days from the date you asked for the hearing.