Alaska Medicaid Eligibility: When to file a Fair Hearing Request

• A baby is automatically eligible for Medicaid for their first year IF born to a mother who was receiving Medicaid in the month of delivery. (First year = last day of the month in which the baby turns 1 year old) MAGI Manual 816-1 (A)
• A Medicaid application gets no response from DPA within 30 days. 
  • or 90 days if a disability determination is required (i.e. Waiver, TEFRA); 7 AAC 100.018
  • or 45 days if the application is for MAGI or Adult Disabled Long Term Care Medicaid (MAGI Medicaid Manual, 806-2; ADLTC Manual, 522 B(1))
• A person is terminated from Medicaid, but DPA did not send them any notice of termination.
• A person is terminated from one type of Medicaid, but DPA did not check if they were eligible for another type of Medicaid (the notice should show the analysis).
• A person is terminated from Medicaid, but they receive SSI (not SSDI).
• A person is terminated from Medicaid, but their household income has not increased and:
  • the person is currently pregnant or within one year after giving birth
  • the person is under 21
  • MAGI Manual 816-1(B-G)
• A person was approved for Medicaid, but didn't get the backdated coverage they should have received.
• A person was approved for Medicaid, but the approval notice doesn't list everyone in the person's household.
• A person receives a notice that their Medicaid Waiver, Personal Care Services, or Day Habilitation benefits are being reduced or terminated.

Note: A fair hearing request must be made in writing, but any writing counts.
AlaskaLawHelp: Fair Hearings - How to appeal Alaska public benefits denials or delays.
ALSC has made an online, fillable fair hearing request form for Community Navigators.

In Alaska, fair hearing requests for programs administered by Senior Disability Services (SDS) have a different destination than for Medicaid eligibility issues handled by the Department of Public Assistance (DPA).

If the issue involves Medicaid eligibility for any Medicaid programs: 

• Email the completed form, or writing, to hss.dpa.offices@alaska.gov or fax it to (888)269-6520. Save your sent email or proof of faxing.
• DPA has 10 days to respond.

If the issue involves Medicaid Waiver services, Personal Care Services, or Day Habilitation:

• Send a written request for a fair hearing by email to fairhearings@gainwelltechnologies.com, by fax to 907.644.8126, or by mail to: Fair Hearing Representative P.O. Box 240808 Anchorage, AK 99524.
• SDS has 10 days to respond. 

A Medicaid applicant or beneficiary should apply for help from ALSC immedietly if:

• A fair hearing request was submitted, and DPA did not respond within 10 days. (we would need proof of the submission) 
• A patient's Medicaid application is denied and the only reason is that they are slightly over income.  The denial letter may recommend a Miller Qualifying Income Trust. 

To apply for help from ALSC, see the instructions on our website.