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Bureau of State Hearings
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In order to best protect confidential and other important data, the ODJFS website will no longer support several outdated web browsers. Effective December 5, Internet Explorer 6 or older, Opera 4 or older and Netscape Navigator will no longer work on ODJFS sites that are https-enabled. Individuals can download the most recent version of Internet Explorer here and the most recent version of Opera here.

Ask for a State Hearing

NOT FOR COUNTY USE

If your issue is about a managed care plan service denial, termination, reduction, or suspension, you must first appeal through your managed care plan. If you do not know your managed care plan phone number, please call the Ohio Medicaid Consumer Hotline for assistance at 1-800-324-8680.

You can ask for a state hearing, if you disagree with what we are doing or think we are making a mistake.  A hearing officer representing ODJFS and Medicaid will make a decision after the hearing.  If you want a hearing, we must receive your request 90 days from the date this notice was mailed to you.  If the 90th day falls on a holiday or weekend, the deadline will be the next work day.  If we receive your hearing request within 15 days of the notice mail date, your benefits or services will not be stopped or lowered until a hearing decision is issued.   To request a state hearing, please fill in the following information:

* Indicates Required Field

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Case Number:
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First Name:
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Last Name:
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Address:
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City:
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State:
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Zip Code:
 
Phone Number with Area Code:
 
Email Address:
 
Agency that took the Action:
 
Notice Mail Date:
 [None] Select a Date Delete the Date
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Select all the programs that apply to this request: (select at least one)

If your program is not listed below, call us at 1-866-635-3748 or select OTHER and provide details in the description area.









   


 The following information is OPTIONAL:

 
Are you requesting a hearing about the denial of your Managed Care Service?
                                  
 
Are you requesting a hearing about the denial of your Waiver Services?
                                  
 
Are you requesting a hearing about the denial of your Service?
                                  
 
Please provide a brief description of the issue(s) in the space below: (450 character limit)
 
 
Please list any interpretation needs:
 
 
Would you like someone from State Hearings to help with resolving your issue(s)?
                                  
 
Would you like a County Conference?
                                  
 
Do you want to discontinue your benefits?
                                  
 
If you want to complete your hearing by phone, please provide phone number with area code where you can be reached:
 

 

If you are an authorized representative, you must use one of the other ways below to make a state hearing request (and you must provide authorization to represent documentation along with the state hearing request):

    Email – bsh@jfs.ohio.gov. In the subject, put “State Hearing Request”.
    Fax – (614) 728-9574
    Mail – ODJFS Bureau of State Hearings, P.O. Box 182825, Columbus, Ohio 43218-2825.
    Drop off this form to your caseworker – It is much better to send the request by one of the ways listed above.

 

While you are awaiting your hearing, consider reapplying for assistance by visiting https://odjfsbenefits.ohio.gov/SelfServiceSplash.jsf.

On the Day of the State Hearing: You, or someone else helping you with your case, can explain the reason(s) why you don’t think the decision is right. An agency representative will explain the reasons. The hearing officer may limit the number of witnesses allowed in the hearing at any one time if there is not enough room. You and your representative will have the right to look at the evidence used at the hearing, present your side of the case without undue interference, ask questions, and bring papers or other evidence to support your case. The hearing will be recorded by the hearing officer so that the facts are taken down correctly. After the hearing decision is issued, you can get a free copy of the recording by contacting the Bureau of State Hearings. The hearing officer will listen to both sides but will not make a decision at the hearing. Instead, you will receive a written decision in the mail issued by the hearing authority.

You can ask your local Legal Aid program for free help with your case. Contact your local Legal Aid office by phoning 1-866-LAW-OHIO (1-866-529-6446) or by searching the Legal Aid directory at http://www.ohiolegalhelp.org/find-legal-help/.    

By typing your electronic signature below, you are saying you are the person requesting the Bureau of State Hearings to process a state hearing request for you.

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Signed (type your full name):
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Date:
 [None] Select a Date Delete the Date