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Ask for a Fair Hearing for Medicaid Benefits
You can ask for a fair hearing (an appeal) if:
? You have been denied Medicaid
? Your Medicaid benefits have been cut
? Your Medicaid benefits have changed.
If you want a fair hearing, call your county Department of Family and Children?s Services today. Then fill out this form. Bring it or mail it to your county Department of Family and Children Services.
By: Georgia Legal Services Program
Other Formats:
Word File
OSAH Form 1 - DFCS Request for Fair Hearing with Office of State Administrative Hearings
(Separate Website)
When you have been denied Medicaid or had your Medicaid Benefits lowered or terminated, you can ask for a fair hearing. You can fill out a fair hearing request letter and mail it or deliver it to your local Division of Family and Children Services (DFCS) office to begin the process. When DFCS gets your letter asking for a fair hearing, they use this form to process your appeal with the Office of State Administrative Hearings (OSAH). You can give DFCS this form and ask them to fill it out and send it to OSAH and to the Department of Human Resources Legal Services to process your appeal.
By: Georgia Department of Human Resources
Other Formats:
Word File
Adobe Acrobat Reader required. (If you are using a screen reader that does not support PDF format, copy the PDF link, and use the Access Adobe online form to convert this file to HMTL text.)
LegalAid-GA is a project of Atlanta Legal Aid Society, Georgia Legal Services Program and the Pro Bono Project of the State Bar of Georgia. The project is funded by the Legal Services Corporation and the Georgia Access to Justice Project.
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Word File
(Separate Website)
