Medicaid Fair Hearings in NYS - Common Links and Changes

Medicaid recipients  have the right to request a Fair Hearing to appeal an adverse action.  This includes decisions made  by a managed care or Managed Long Term Care plan, by the local Dept. of Social Services, or by NYS's contractor, NY Medicaid Choice or the NY Independent Assessor. 

This is not an exhaustive article about fair hearings.  See information here about TELEPHONE HEARINGS, which became the main method of holding hearings during the COVID pandemic.  THis was a big change from the priof model of holding in-person hearings UNLESS an individual was "homebound," and then a telephone hearing could be held.    

In this article:

1. Key Links and Websites

2. NEW PRO SE RESOURCE:  Fair Hearing Help NY website 

3. Medicaid Advantage Plus (MAP) or "FIDE"  Hearings -- WARNING  

4. OTDA Fair Hearing Phone Call-In Pilot - Beginning 2026

5. OTDA Telephone Hearings  Telephone Demonstration in Place since 2020

6. NYS 2025 Fair Hearing Compliance Plan - "PHD" or Pre-Hearing Determinations - click here

1. Key Links and Websites

• Fair Hearing Resources webpage on the WNYLC Online Resource Center. - managed by Gene Doyle, has extensive information, reference lists, guidance, info on litigation, etc. 

• NYS Office of Temporary & Disability Assistance  (OTDA) Fair Hearing Website - has forms to request, adjourn or withdraw fair hearing requests, or request FH online

  • Request a Fair Hearing - can be completed online, by US Mail, by telephone or by fax. (or in person in NYC and Albany only - note in-person address changed Dec. 2024).

    • Expedited Hearings -  22-03 Fair Hearings Transmittal Expedited Medicaid Hearings  explains how to request and standards for expediting

  • Request an Adjournment or Reopening 

  • OTDA  Administrative Hearing Transmittals  - new section on OTDA webpage (May 2023) -such as: 

    • 22-03 Fair Hearings Transmittal Expedited Medicaid Hearings

  • Fair Hearing Archive - searchable database of all FH decisions since 2010 

  • Telephone Hearings - see more  below  for info about the Phone Hearing Demonstration that started in COVID, and here for telephone hearings for people who are homebound

  • OTDA Fair Hearing Unit Contacts:

    • Fax: 518-473-6735

    • Phone: 1-518-474-8781 or 1-800-342-3334 (toll free)

  • E-mail address to request re-opening or correction of a Fair Hearing decision Litigationmail.Hearings@otda.state.ny.us  (WARNING:  Requesting reopening or correction does NOT toll the four-month statute of limitations to file an Article 78 proceeding in Supreme Court.  Under a longstanding policy, non-profit legal services organizations may request that because they are making the request to re-open in lieu of litigation, that in the event that the reopening request does not resolve the matter, that the Office of Temporary and Disability Assistance (“OTDA”) not invoke the Statute of Limitations regarding an Article 78 proceeding, provided that the Article 78 is brought within 30 days from OTDA’s determination of the  reconsideration request.

• Manual for Administrative Law Judges and Hearing Officers (publication of the New York State Department of Civil Service, not OTDA) -- originally published in June 2002 and substantively updated once. A list of  revisions made in 2005 is found immediately after the title page.   OTDA has endorsed and cited the Manual in its training of ALJs. See  April 13, 2005 memorandum on "Fair Hearing Training; Meachem v Wing." The Manual is occasionally cited or even quoted in Fair Hearing Decisions. See e.g. FH #: 8198522J, 7579155Z, 7435426Q, 6786824H, and 6056905P.

• New York City HRA Medicaid Fair Hearing Division contacts - click here. (updated July 2025 with new contacts announced here)(to request case file, to contact HRA about compliance with a Fair Hearing decision or Aid Continuing directive)

2.  NEW PRO SE RESOURCE:  Fair Hearing Help NY website 

http://fairhearinghelpny.org/ - Developed in collaboration with the Lawyering in the Digital Age Clinic at Columbia Law School, Empire Justice Center, The Legal Aid Society, and New York Legal Assistance Group, FairhearinghelpNY.org offers self-represented people information that will allow them to more fully participate in their Fair Hearting and exercise their due process rights.  Emphasis is on public benefits, not Medicaid. 

Medicaid Advantage Plus (MAP) or "FIDE"  Hearings -- WARNING -  

The NYS OTDA Fair Hearing website above cannot be used for Medicaid Advantage Plus (MAP) plans, also called FIDE plans (Fully integrated Dual Eligible).  These hearings are operated under a unique "integrated" hearing system, which covers both Medicaid and Medicare denials by MAP plans. MAP plans use different notices.  The big difference is that the member does not have to request a fair hearing!  The plan is required to  AUTOMATICALLY forward all adverse decisions after a plan appeal for a hearing to be scheduled. See more about MAP FIDE hearings here. 

Important 2025 Update: The integrated appeal and fair hearing process launched for in 2020 for MAP plan members is being phased out to end Jan. 1, 2026. See the DOH MAP Integrated Hearings Phase-out plan here. 

• Some integrated hearings will still be held after Jan. 1, 2026 for appeals where the MAP plan denied the member's "plan appeal" of an initial denial notice in 2025.  
• See NYLAG's comments about the DOH MAP Phase-Out Plan here and the NYS DOH’s June 16, 2025 phase-out plan here.

• Check to see which type of MLTC plan your client is in - regular MLTC or a MAP.  Now that nearly 38,000 people are in MAP plans, it's important to check.  Just knowing the name of the insurance company doesn't help, since companies operate both a regular MLTC plan and a MAP plan.  Ask the client for their membership ID or a notice with the official name of the plan, and then check in a few places:

  1. See plan lists for "long term care" plans on the NY Medicaid Choice website, (Scroll down to long term care plans for your region), 

  2. See NYS DOH MLTC Plan Directory ("Partial" = "regular" MLTC) 

  3. NY Medicaid Choice site - at the bottom of the home page click on  Sitemap -→ Main Menu → Enroll → Check My Case - complete the form - need consumer's date of birth and NYS Benefit ID number or case number.

• MAP:  OTDA Integrated Appeal Hearing Office (IAHO)   1 (844) 523-8777

4. OTDA Fair Hearing Phone Call-In Pilot Beginning in 2026  

Beginning in January 2026, the Office of Temporary and Disability Assistance’s (OTDA), Office of Administrative Hearings (OAH) will start a new pilot program for telephonic fair hearings. Under the new process, appellants residing in identified counties and their representatives must “call in” at a specific time to start their scheduled fair hearings. Failure to start the fair hearing by calling in at the appointed time may result in the fair hearing being designated abandoned. OAH expects to extend this pilot statewide by summer 2026.  A letter describing this pilot program can be found here. A draft of the new call in phone hearing insert (457-XL001D draft) which will be included with the scheduling notice can be found here. The draft roll-out schedule by county can be found here. The roll-out and insert remain subject to change.

All categories of hearings will be included in the call in the pilot except Emergency Assistance, Department of Homeless Services, and Expedited Medical Assistance hearings. These hearings will be scheduled with OAH calling appellants and their authorized representatives or scheduled with one or more parties appearing in a specific physical location.

Instructions for the day of your Fair Hearing:

• On the day of the hearing, call (518) 560-4126 between 10 minutes before and 30 minutes after your scheduled hearing time in Box H of the enclosed Notice of Fair Hearing, (Form OAH 457). You will not be able to join the hearing outside this 40-minute window.  
   
• When prompted, use the phone’s number pad and enter the digits for your individual fair hearing number in Box A of the enclosed Notice of Fair Hearing (Form OAH 457).  Do not enter the letter at the end of your fair hearing number.
   
• You will be placed on hold until the Administrative Law Judge is available.
   
• You will be able to follow prompts and make yourself unavailable for up to five (5) minutes.
   
• Your hearing request may be considered abandoned if you do not call as directed or are not present when the Administrative Law Judge starts your hearing.

 These instructions are included in the draft telephonic fair hearing insert available here.

 Tentative Pilot Roll Out Schedule

• January 19, 2026: Begin scheduling for weeks of February 9 and 16 in Broome and Dutchess
• February 2, 2026: Schedule for week of February 23 adding Clinton, Genesee, Greene, Franklin, Oswego
• February 9, 2026: Schedule for week of March 2 adding Monroe, Wyoming, Yates, Schuyler, Tioga
• February 16, 2026: Schedule for week of March 9 adding Jefferson, Herkimer, Lewis, Livingston, Tompkins, Montgomery
• February 23, 2026: Schedule for week of March 16 adding Onondaga, Fulton, Ontario, Madison, Washington, Schoharie
• March 2, 2026: Schedule for week of March 23 adding Niagara, Cayuga, Chautauqua, Chenango, Cattaraugus
• March 9, 2026: Schedule for week of March 30 adding Suffolk, Oneida, Rockland, Orange, Allegany, Essex
• March 16, 2026: Schedule for week of April 6 adding Columbia, Rensselaer, Saratoga, Warren, Albany, Schenectady
• March 23, 2026: Schedule for week of April 13 adding Westchester, Chemung, St Lawrence, Seneca, Steuben
• March 30, 2026: Schedule for week of April 20 adding Nassau, Cortland, Otsego, Orleans
• April 6, 2026: Schedule for week of April 27 adding Erie and Ulster
• April 13, 2026: Schedule for week of May 4 adding NYC
• April 20, 2026: Schedule for week of May 11 adding Sullivan, Wayne, Delaware, Putnam, Hamilton
  
  The draft Fair Hearings Phone Hearing Call-in Pilot Rollout Schedule is available here.

https://otda.ny.gov/hearings/telephonic-hearings.asp   

• Before the COVID pandemic, telephone hearings were only available to people determined to be "homebound," meaning that because of mental or physical disabilities, they cannot travel to a fair hearing without substantial hardship or medical detriment.  This is under the Varshavsky class action injunction. See more about Varshavsky  procedures in this article. Under Varshavsky, if a "homebound" person lost the telephone hearing, OTDA could only issue an hearing decision that was wholly favorable for the appellant. Otherwise, OTDA must schedule a second part of the hearing in the appellant's home. Meanwhile, the appellant may be entitled to an increase in hours pending that home hearing.  

• A telephone hearing demonstration program in which virtually all hearings are held by telephone was launched in  March 2020.  This demonstration was most recently extended through March 12, 2025 in  24-01 Continuing Demonstration Project on Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means - March, 5, 2024.

• See previous extensions of this demonstration here. Under the demo, all hearings are held by phone, video "or other means,"  unless the appellant requests the hearing to be held in-person, or the ALJ or OTDA finds an in-person hearing should be held. 

• Procedures: See 25-01 Continuing Demonstration Project on Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means (which is more recent than FAQ - April 16, 2020 -  OTDA OAH Transmittal 2020-03 - Frequently Asked Questions about Phone Hearings.

• How to Submit Evidence at Phone Hearing - see Telephone Hearing website  - include Fair Hearing Number on all fax or mail cover sheets.

  • Upload -  New process for Appellants and Representative to upload evidence for fair hearings using www.upload.ny.gov.   

  • E-Mail - may submit evidence by email to mailto:
    intakemail.hearings@otda.ny.gov  but this is NOT SECURE.  

  • FAX used for requesting fair hearings.. FAX 518-473-6735

  • MAIL  to OAH, 40 N. Pearl St. Fl. 15B, Albany, NY 12243

  • MAP hearings - see article on MAP/FIDE hearings

• WHEN - must submit documents TWO BUSINESS DAYS before Fair Hearing 

• Local districts or Managed care plans must provide documents they plan to submit to the Appellant and their rep to be received at least one day in advance. 

  • " Agencies may request to waive personal appearance at any hearing. OAH may draw a negative inference if an Agency representative is needed and not available to participate or contact information is not provided. Agencies planning to have a representative participate in the hearing should make specific reference thereto in the coversheet, summary, and encrypted email. Failure to request contact may result in a decision being issued based on documentary evidence alone. OAH will generally not reopen the hearing under such circumstances."  23-01 Continuing Demonstration Project on Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means p. 3. 

• How Hearing is conducted -- Please see the 23-01 Continuing Demonstration Project on Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means  for detailed information on how the phone hearing is conducted  - how the Caller ID number may appear, three-way calls, etc.  Here are just a few excerpts from this directive:

  • "Hearing Officers will contact the parties at the provided phone numbers. If there is no answer, Hearing Officers will try to leave voice messages. Hearing Officers will call Appellants and their authorized representatives two times with at least ten minutes between calls. If the Appellant and their authorized representative fails to answer, OAH may deem the request for a fair hearing abandoned in accordance with 18 NYCRR § 358-5.5. OAH will attempt to advise Agencies if hearing requests are withdrawn prior to the hearing date or if the Appellant or Appellant’s representative fails to participate in the hearing."  23-01 Directive at  p. 5

  • "Hearing Officers will conference all participants into the telephonic hearing and may permit parties to add others to develop a complete record. All parties will be identified. The audio component of hearings will be recorded. Only OAH may record the fair hearing (see, 18 NYCRR § 358-5.11). Hearing Officers will generally inquire whether the Appellant and their authorized representative received a copy of the Agency’s evidence and if the Appellant submitted evidence."   23-01 directive at p. 

• ADVOCACY: Letter to OTDA 3/24/20 Requesting Clarification of GIS above and for protections for appellants in the new phone hearing procedures - from NYLAG, Legal Aid Society, Empire Justice Center & other organizations.

• Phone Contact to OTDA re Scheduling, Adjournments, Etc.
  • MAP:  IAHO           1 (844) 523-8777
  • MLTC: OTDA OAH 1 (800) 342-3334

 NYS OTDA - Previous Directives about the Telephone Hearing Demonstration:     

1.  Office of Administrative Hearings Transmittal 20-02; 20 TA/DC014 – Hearings by Phone (3/12/2020)  Initial demonstration is from March 12 to Sept. 12, 2020 

2. FAQ - April 16, 2020 -  OTDA OAH Transittal 2020-03 - Frequently Asked Questions about Phone Hearings 

3. GIS 20 TA/DC-076:  “Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means"  (July 17, 2020) (EXTENDED TO March 12, 2021)

4. 20 GIS TA/DC 097 – NYS OTDA Office of Admin. Hearings (OAH) Transmittal 20-05 - Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or other Electronic Means - (10/16/20) continues  through March 12, 2021, 

5. 21 TA/DC 013 – OAH Transmittal 21-1 - Demonstration Project Conducting Hearings by Telephone Video and Other Means of Communication (3/15/2021) - continues through March 12, 2022."

6.  22TA/DC024 — Demonstration Project — Conducting Hearings by Telephone, Video, and Other Means of Communication (03/11/22)

7. 23-01 Continuing Demonstration Project on Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means (Mar. 10, 2023)  

For more information

Legal Services NYC Video Series on Fair Hearings 

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.