Overview
If you do not agree with action taken by DHS, you may be entitled to a fair hearing to appeal the decision. DHS’ Bureau of Hearings and Appeals reviews and decides on more than 280 issues for the departments of Human Services and Aging.
DHS’ Bureau of Hearings and Appeals reviews actions like:
- ductions, suspensions, or terminations of public assistance benefits like Medicaid, Supplemental Nutrition Assistance Program (SNAP), cash assistance, or subsidized childcare benefits;
- Level of care determinations for home and community-based services or nursing home care;
- License sanction or revocation against a DHS-licensed service provider;
- Responsibility of payment for persons who are either receiving in-patient or out-patient care in mental health facilities;
- Establishment of family service plans for people receiving services through their county children and youth agency;
- Adoption subsidy cases and foster care benefit case;
- Outcomes of an application for Low-Income Home Energy Assistance cash payments;
- Denials, suspensions, or terminations for providers in the Medicaid program;
- Indication of child abuse or neglect under the Child Protective Services Law;
- And others.
Additionally, DHS’ Bureau of Hearings and Appeals has jurisdiction over the following matters overseen by the Department of Aging:
- Denial of PACE prescription benefits;
- Denial, reduction, or termination of adult day care services; and,
- Reports of elder abuse.
All hearings are conducted in accordance with the regulations found at Title 55 Pa. Code, Chapter 275 (and 6 Pa. Code, Chapter 3 for Department of Aging appeals).
Hearings for non-recipient related appeals are conducted in accordance with Title 1 Pa. Code Chapters 31, 33 and 35, and Medical Provider appeals are conducted under Title 55 Pa. Code Chapter 41.
Filing an Appeal with DHS’ Bureau of Hearings and Appeals
When the Department of Human Services (DHS) or the Department of Aging (PDA) notifies the applicant or recipient that benefits or payments have been denied or will be reduced, suspended, or terminated, or if the provider or license holder receives and adverse decision or sanction, they have the right to request a fair hearing to dispute this action.
In most cases, appeals must be filed in written format, except in Supplemental Nutritional Assistance Program (SNAP) cases. An oral appeal can be filed to dispute an adverse action regarding SNAP benefits.
Appeals are filed with the DHS office that made the action. You must file an appeal within a set time frame. The letter outlining DHS’ action includes information about how and when to file your appeal.
When a request for an appeal is received, it is then forwarded to the Bureau of Hearings and Appeals. They will begin scheduling the appeal and will send you more information about what is necessary to dispute the action.
Appeals are filed with the DHS office that made the action. You must file an appeal within a set time frame. The letter outlining DHS’ action includes information about how and when to file your appeal.
If you have questions about how to file an appeal, contact the phone number listed on your letter.
An Administrative Law Judge will be assigned to each case. The responsibilities of the Administrative Law Judge include conducting the hearing in an orderly manner and obtaining testimony and evidence from both parties.
Hearings may be conducted over the phone or in person. Most recipient cases are handled via phone.
When a hearing is held in person, the appellant and the DHS' representative travel to the regional Bureau office and the hearing is conducted by the Administrative Law Judge with the parties present. The hearing method (telephone or in-person) is the appellant's preference. Whether in person or by phone, hearings are conducted in accordance with 55 Pa. Code, Chapter 275 (and also 6 Pa. Code, Chapter 6 in Aging appeals).
The Administrative Law Judge prepares a written decision (adjudication) based upon the facts and evidence. The decision or recommendation contains a statement of the issues, findings of fact, a discussion, and a ruling of the Administrative Law Judge. The adjudication of a DHS applicant or recipient appeal is then subject to review by the Director of BHA and can be affirmed, amended, reversed, or remanded.
In a PDA appeal, the Administrative Law Judge writes an adjudication in the form of a proposed report to the Secretary of the Department of Aging (or Chief Counsel designee). The Secretary of Aging or Chief Counsel designee may accept the proposed report immediately or issue it to the parties to file exceptions to (i.e. arguments against) the proposed report. The parties have 30 days to submit any exceptions. At the end of the 30 days, the Secretary of Aging or Chief Counsel designee will issue a Final Order to accept the proposed report or reverse it.
Frequently Asked Questions
If either party to an appeal disagrees with the Bureau of Hearings and Appeal’s decision, they may appeal to Commonwealth Court and/or seek reconsideration by the Secretary of Human Services.
A request for reconsideration must be filed within 15 days of receiving the decision by the Bureau of Hearings and Appeals. If they choose to pursue reconsideration, they may still appeal to Commonwealth Court following reconsideration. Petitions to Commonwealth Court must be made within 30 days of the order
A petition to Commonwealth Court must be filed with the Clerk of Commonwealth Court of Pennsylvania, 601 Commonwealth Avenue, Suite 2100, P.O. Box 69185, Harrisburg, PA 17106-9185.
Decisions are typically rendered within 90 days of the date the appeal is filed for most issues. SNAP decisions are typically rendered within 60 days from the ate the appeal is filed. Exceptions may exist depending on various factors, such as rescheduling of hearings.
Certain cases may qualify for Interim Relief. Please contact your program office to determine whether you qualify for Interim Relief.