State Fair Hearings
A state hearing is a meeting with you or someone you want to speak on your behalf, someone from the County Department of Job and Family Services, someone from AmeriHealth Caritas Ohio and a hearing officer from the Bureau of State Hearings within the Ohio Department of Job and Family Services (ODJFS).
In this meeting, you will explain why you think AmeriHealth Caritas Ohio did not make the right decision and AmeriHealth Caritas Ohio will explain the reasons for making our decision. The hearing officer will listen and then decide who is right based on the rules and the information given.
AmeriHealth Caritas Ohio will notify you of your right to request a state hearing if:
- We do not change our decision or action because of your appeal.
- A decision is made to propose enrollment or continue enrollment in the Coordinated Services Program (CSP).
- A decision is made to deny your request to change your Coordinated Services Program (CSP) provider.
You may only request a state hearing after you have gone through AmeriHealth Caritas Ohio’s appeal process.
If you want a state hearing, you, or someone you want to speak on your behalf, must request a hearing within 90 calendar days. The 90-calendar day period begins on the day after the mailing date on the hearing form. If your appeal was about a decision to reduce, suspend, or stop services before all the approved services are received, your letter will tell you how you can keep receiving the services if you choose to and when you may have to pay for the services.
If we propose to enroll you in the Coordinated Services Program (CSP) and you request the hearing within 15 calendar days from the mailing date on the form, we will not enroll you in the program until the hearing decision. Learn more about the Ohio law on this website: https://codes.ohio.gov/ohio-administrative-code/rule-5101:6-3-02
To request a hearing:
- You can sign and return the state hearing form to the address or fax number listed on the form.
- Call the Bureau of State Hearings at 1-866-635-3748.
- Submit your request via e-mail at email@example.com.
If you want information on free legal services but don’t know the number of your local legal aid office, you can call the Ohio State Legal Services Association at 1-800-589-5888.
State hearing decisions are usually issued no later than 70 calendar days after the request is received. However, if MCO or the Bureau of State Hearings may decide that the health condition meets the criteria for an expedited decision. An expedited decision will be issued as quickly as needed but no later than three working days after the request is received. Expedited decisions are for situations when making the decision within the standard time frame could seriously jeopardize your life, your health or your ability to attain, maintain, or regain maximum function.