Hearings

When a Medicaid member, provider, or other interested party is dissatisfied with an action taken by Utah Medicaid, a hearing may be requested by filing a hearing request with the DHHS Office of Administrative Hearings (OAH). Hearing requests to Medicaid include requests to dispute disability decisions made by the DHHS Medical Review Board (MRB). 

Hearing requests must be filed by the filing deadline.

  • Providers: When a provider wishes to appeal a payment reflected by an explanation of benefits, or other remittance document issued by Medicaid, the hearing request must be filed within 30 calendar days of the date of the remittance document.
  • Members: When a member wishes to appeal a Medicaid or CHIP eligibility or disability decision, the hearing request must be filed within 90 days from the date of the notice they disagreed with.

Managed care plan hearing request

A member or provider wishing to dispute an action taken by an Accountable Care Organization or Managed Care Entity must complete the appeal process within that organization before filing a hearing request with OAH.

Medicaid eligibility fair hearing requests

Although, OAH handles hearing requests to dispute disability decisions made by the MRB, OAH does not handle disputes regarding eligibility decisions for Medicaid or CHIP.  Fair hearings for Medicaid and CHIP eligibility should be filed with the Department of Workforce Services (DWS), Division of Adjudications here.

Administrative hearings for other DHHS divisions

The OAH conducts fair hearings for some divisions outside DHHS including: Division of Child and Family Services (DCFS), Division of Services for People with Disabilities (DSPD), Office of Recovery Services (ORS), Division of Licensing and Background Checks, and Adult Protective Services.  These hearings are received within their respective divisions.

How to request a Medicaid fair hearing

You can fill out the State Fair Hearing Request Form available here, and email the form as an attachment to utmedicaidhearings@utah.gov.

If you prefer to mail your request, you may use the mailing addresses listed below:

Mailing Address:

Department of Health and Human Services
Office of Administrative Hearings
PO Box 143105
Salt Lake City, UT 84114-3105

If you have any questions about your request, contact the Office of Administrative Hearings using one of the methods below:

Email: utmedicaidhearings@utah.gov.
Phone: 801-538-6576
Fax: 801-536-0143

Street Address:

Department of Health and Human Services
Office of Administrative Hearings
195 North 1950 West
Salt Lake City, UT 84111

Additional information

Additional information on fair hearings is contained in the Utah Medicaid Provider Manual, General Information – Section I, Chapter 5, section 4 (pg. 35)-4.

Laws and rules:

  • 42 Code of Federal Regulations Part 431, Subpart E
  • 42 Code of Federal Regulations Part 438, Subpart F
  • Utah Administrative Procedures Act: Utah Code Annotated, Title 63G, Chapter 4
  • Utah Administrative Code, Title R410: Administrative Hearing Procedures