What is a Fair Hearing?
A. Medicaid managed care enrollees have the right to ask for a Fair Hearing for many types of problems. A Fair Hearing is when you tell your problem to an independent State judge, called an Administrative Law Judge. Usually, a New York City employee explains either the City’s side of the story or a managed care employee will explain the health plan’s side of the story. If your problem concerns a medical decision that the plan made, the plan must provide information to the City about your case. Sometimes the managed care plan will send an employee to explain its side. You will get a chance to explain your side of the story to the judge too. The judge must make a decision within 90 days of the date you asked for a Fair Hearing.
