Current through Register Vol. 46, No. 39, September 25, 2024
(a) An
applicant or recipient has the right to challenge certain determinations or
actions of a social services agency or such agency's failure to act with
reasonable promptness or within the time periods required by other provisions
of this Title, by requesting that the OAH provide a fair hearing. The right to
request a fair hearing cannot be limited or interfered with in any
way.
(b) If you are an applicant or
a recipient of assistance, benefits or services you have a right to a fair
hearing if:
(1) your application has been
denied by a social services agency, or you have agreed in writing that your
application should be withdrawn but you feel that you were given incorrect or
incomplete information about your eligibility for the covered program or
service; or
(2) a social services
agency has failed to:
(i) determine your
eligibility for a covered program or service with reasonable promptness or
within the time periods required by other provisions of this Title;
(ii) issue or adjust your cash
grant;
(iii) issue or adjust your
food stamp benefits; or
(iv)
authorize medical care or services for you; or
(3) your public assistance, medical
assistance, food stamps or services have been discontinued, suspended or
reduced, or your public assistance, medical assistance or food stamps have been
increased; or
(4) the method or
manner or form of payment of all or part of your public assistance grant has
been changed, a restricted payment is being made or is being continued or a
medical assistance authorization is restricted; or
(5) you object to the payee selected for a
restricted payment; or
(6) your
public assistance, medical assistance, HEAP or services are inadequate;
or
(7) although there has been no
change in the amount of your public assistance grant, medical assistance
spenddown or food stamp benefits, you wish to challenge the social services
agency's determination that the amount of one of the items used in the
calculation of your public assistance grant, medical assistance spenddown or
food stamp benefits has changed; or
(8) your request for restoration of any food
stamp benefits lost less than one year prior to the request for restoration has
been denied; or you do not agree with the amount of food stamp benefits
restored or any other action taken by the social services agency to restore
such benefits; or
(9) your food
stamp benefits have been reduced, suspended or cancelled as a result of an
order issued by the United States Food and Nutrition Service to reduce
allotments because the requirements of states participating in the Food Stamp
Program will exceed appropriations; however, in such case you have the right to
a fair hearing only if you believe that your benefit level was computed
incorrectly under Federal rules, or that Federal rules were misapplied or
misinterpreted; or
(10) you are
aggrieved by a mass change in the Food Stamp Program; or
(11) within a certification period, the
amount of your food stamp benefits is inadequate and you have made the request
for a fair hearing within such certification period; or
(12) your application for food stamp benefits
has been denied or your food stamp benefits have been reduced or discontinued
due to a determination that you are not exempt from Food Stamp Program work
requirements and that you have failed to comply with work registration or
employment and training requirements. You may request a fair hearing to review
such determination including the determination of exemption status, the type of
requirement imposed, or a social services agency's refusal to make a finding of
good cause for failure to comply with such requirements if you believe that the
finding of failure to comply was improper; or
(13) you are required to participate in a
service, except when required to do so by court order; or
(14) you are an applicant for or a recipient
of public assistance and you object to a social services agency determination
that you are not exempt from work program requirements or to the determination
that you are not work-limited as provided by section
385.2
of this Title; or
(15) you object
to the amount deducted from your initial payment of supplemental security
income as reimbursement of public assistance; or
(16) the amount you are being charged for a
service has been increased and such increase is not based on a change in the
fee or family share schedule; or
(17) you disagree with the amount of a claim
for the overpayment of public assistance or the over-issuance of food stamp
benefits, except if the amount of such claim has already been determined in
accordance with Part 359 or 399 of this Title, by an administrative
disqualification hearing, a waiver for an administrative disqualification
hearing, a court determination or a disqualification consent agreement;
or
(18) you are a recipient of
medical assistance and you have reached a utilization threshold and your
application for an exemption from or increase to such threshold has been
denied; or
(19) you are
participating in a work-related program or activity under Part 385 of this
Title and you have a complaint regarding the calculation of your hours of
participation in work experience or in work experience as part of community
service; or
(20) you have been
denied a waiver of public assistance program requirements under section
351.2(l)
of this Title or an extension of such waiver has been denied or such waiver has
been terminated or modified.
(c) As the sponsor of an alien receiving food
stamp benefits and for whom there has been an over-issuance of benefits for
which you are liable, you have a right to a hearing to contest the following:
(1) the determination that you were
responsible for the incorrect information which was provided and which resulted
in the over-issuance; and
(2) the
amount of the over-issuance for which you are liable.
(d) As a relative or friend of a deceased
person, you have a right to a fair hearing if you have paid for the burial
arrangements of such deceased person and your claim for reimbursement made
pursuant to section 141 of the Social Services Law is denied by
the local social services agency.
(e) As a recipient of food stamp benefits,
you do not have the right to a fair hearing to challenge the following:
(1) the placement of your household on an
alternate issuance system; or
(2)
the length of time that your household is required to participate in an
alternate issuance system; or
(3)
an adverse decision in an administrative disqualification hearing; or
(4) a disqualification penalty imposed after
you have waived your rights to an administrative disqualification
hearing.
(f) As an
applicant or recipient you do not have the right to a fair hearing in all
situations. For example, you do not have a right in the following situations:
(1) the Department of Health has discontinued
payment to the medical facility in which you are or had been residing because
the facility has been decertified from participation in the Medical Assistance
Program; or
(2) your physician has
ordered a change in the level of care being provided to you; or
(3) a utilization review committee has
ordered a higher level of care; or
(4) the sole issue involving your receipt of
medical assistance is a Federal or State law requiring an automatic change
which adversely affects some or all recipients; or
(5) you are complaining about the amount of
any lien taken by a social services agency; or
(6) a local social services agency has
demanded restitution, in accordance with the provisions of section 104 or 106-b
of the Social Services Law, of public assistance paid, other than by a
reduction of the public assistance grant; or
(7) you are complaining about the amount of a
child support payment which is passed through to you; or
(8) your services have been discontinued as a
result of a court order, or the court order which required the provision of
services has expired; or
(9) you
are a member of a class of public assistance recipients for whom either State
or Federal law requires an automatic grant adjustment, unless the reason for
your appeal is the incorrect computation of your grant; or
(10) you are a foster family care services
recipient, a foster family caregiver, or a respite caregiver pursuant to
section
505.29
of this Title, and a sponsoring agency terminates the foster family caregiver's
or the respite caregiver's authority to provide foster family care services or
a social services district or the Office of Children and Family Services or the
Department of Health terminates its contract with a sponsoring agency;
or
(11) you have been sent a
request for contact notice in order to verify or clarify information during
your food stamp certification period; or
(12) you have been sent a notice of missed
interview informing you that you have missed a scheduled food stamp eligibility
or recertification interview and advising you that it is your responsibility to
reschedule the interview.
(g) If you are an institutionalized spouse or
a community spouse, as defined in section
360-4.10
of this Title, and a determination has been made on an application for medical
assistance for the institutionalized spouse, you have a right to a fair hearing
to challenge:
(1) the amount of the community
spouse monthly income allowance; and/or
(2) the amount of monthly income determined
to be otherwise available to the community spouse; and/or
(3) the amount of resources attributed to the
community spouse or to the institutionalized spouse; and/or
(4) the amount of the community spouse
resource allowance.
(h)
You have a right to a fair hearing if you are a resident of a shelter for
families as defined in section
900.2 of
this Title and you have been involuntarily discharged from the shelter after
having requested and participated in a hearing, held by the facility or by the
social services district in which the facility is located, to determine whether
you should be involuntarily discharged. If you do not request and participate
in such a hearing you do not have a right to a fair hearing. You also do not
have a right to a hearing under this Part if the basis for the discharge is
that you are or a family member is no longer medically appropriate to reside in
the facility, as determined by qualified medical personnel, you or a family
member's temporary housing assistance has been discontinued pursuant to the
provisions of section
352.35
of this Title or, you have or a family member has been absent from the facility
for more than 48 hours without having complied with the facility's rules
concerning absence and you have not or the family member has not been
readmitted to the facility.
