Introduction and Updates

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 ("LDSS") 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 prior model of holding in-person hearings UNLESS an individual was "homebound," and only then a telephone hearing could be held.    

April 14, 2026 - The NYS Office of Hearings & Appeals (OHA) in the NYS Office of Temprary & Disability Assistance (OTDA) released a new GIS directive announcing the new pilot program requiring appellants and their representatives to call in to the hearing, rather than be called by the judge -- 26-02 Demonstration Project to Increase Appellant Scheduling Control.  See more about this pilot program here. 

April 19, 2026 - This is the last day on which a member of a Medicaid Advantage Plus (MAP) plan may request an initial Plan Appeal of an adverse notice issued by the MAP plan in 2025, using the Integrated Hearing process that is being phased out.  For all MAP plan adverse determinations after Jan. 1, 2026, the member still requests an initial Plan Appeal, but the rest of the appeal process will change to a new bifurcated appeal process.  See more here. 

Which Medicaid Hearings are with NYS OTDA and Which are with the NYSofHealth Exchange?

• APPEALS about MEDICAID or Medicare Savings Program ELIGIBILITY, Applications or Renewals

  • NYSOH -- If the consumer's Medicaid is administered on the NYSofHealth (NYSOH) marketplace,  then you request an appeal of an adverse Medicaid determination with NYSOH - not with NYS OTDA.  Call  (855) 355-5777 to request the hearing. These are mostly consumers who are under age 65 and do not have Medicare -- who have MAGI Medicaid.  But see exceptions below. 

  • NYS OTDA - If  the consumer's Medicaid or Medicare Savings Program is administered by the local Dept. of Social Services (LDSS)(HRA in NYC) then request the fair hearing with the NYS Office of Temporary & Disability Assistance (OTDA) Office of Administrative Hearings (OAH).  This article is about these OTDA hearings. This includes hearings concerning Medicaid eligibiity for:

    • consumers Age 65+, Blind or Disabled,

    • people who applied for Cash Assistance with their Local DSS, which also approved Medicaid and SNAP along with the Cash Assistance;

    • Others who need the County/NYC to administer their Medicaid because they are enrolled in or seeking to enroll in a Medicaid home-and-community based waiver, or in a Managed Long Term Care plan, nursing home care ,or Assisted Living Program, or other long term care services. 

    • SEE EXCEPTIONS below

  • EXCEPTIONS:  RECENT changes starting in 2025 are moving many Medicaid cases that were historically administered by the LDSS to NYSOH.   See this article.  This includes Medicaid and the Medicare Savings Program.  Hearings in those cases must be requested with NYSOH, not with OTDA.  You must check the adverse notice to see where to file the appeal. 

• Hearings involving eligibility for SERVICES - Hearings are held by NYS OTDA.

  • These include services approved  or denied by the Local DSS, or by Medicaid managed care plans, or Managed Long Term Care plans, and

  • Determinations by NY Medicaid Choice and NY Independent Assessor,   

  • NOTE that when appealing determinations by a Medicaid managed care plan or Managed Long Term Care plan, you must first request an internal Plan Appeal with the plan.  This is called "exhausting" the plan appeal process.  When that plan appeal is denied, you may request a Fair Hearing.  See this article about appeals of managed care decisions, including MLTC.  

  • See here and in this article for special rules about appeals of adverse decisions by Medicaid Advantage Plus (MAP) -plans - and changes happening in 2026. 

Key Links and Websites re Hearings with NYS OTDA

• 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)

• See Pro Se Resources Below

Medicaid Advantage Plus (MAP) or "FIDE"  Hearings -- 2026 Changes  

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.  The last day to request an initial Plan Appeal appeal under the old integrated hearing process is April 19, 2926.
• 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  HEALTH PLAN LISTS and then further 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

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

OTDA released a GIS directive announcing this pilot program on April 14, 2026 - 26-02 Demonstration Project to Increase Appellant Scheduling Control.  This directive has the updated roll-out schedule, with certain upstate counties launching first.  This roll out schedule can also be found below.

An earlier 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 original roll-out schedule by county, which has been delayed, can be found here - now replaced by the April 14, 2026 26-02 directive.  The roll-out and insert remain subject to change.

WHICH HEARINGS? 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 and in  OTDA GIS 26-02 Demonstration Project to Increase Appellant Scheduling Control. 

 Tentative Pilot Roll Out Schedule - New dates as of April 14, 2026

This section will be updated as we learn more. in its April 14, 2026 directive, 26-02 Demonstration Project to Increase Appellant Scheduling Control,OAH announced the new dates in 2026 below.   

• Week beginning:May 11: Broome, Dutchess
• May 25: + Clinton, Genessee, Greene, Franklin, Oswego
• June 1: + Monroe, Wyoming, Yates, Schuyler, Tioga
• June 8: + Jefferson, Herkimer, Lewis, Livingston, Tompkins, Montgomery
• June 15: + Erie, Onondaga, Ontario, Madison, Washington, Schoharie
• June 22: + Suffolk, Niagara, Chautauqua, Chenango, Cattaraugus
• June 29: + Cayuga, Oneida, Rockland, Orange, Allegany, Essex
• July 6: + Westchester, Rensselaer, Saratoga, Warren, Albany
• July 13: + Nassau, Chemung, St Lawerence, Seneca, Steuben
• July 20: + Columbia, Cortland, Otsego, Orleans
• July 27: + Fulton
• August 4: + NYC
• August 11: + Sullivan, Wayne, Delaware, Putnam, Hamilton

OTDA TELEPHONE HEARING WEBSITE    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, 2027 in 26-01 Continuing Demonstration Project on Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means

  • 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   26-01 Continuing Demonstration Project on Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means and OTDA OAH Transmittal 2020-03 - Frequently Asked Questions about Phone Hearings.

• How to Submit Evidence at Phone Hearing - see OTDA 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 26-01 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."     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."    p. 5. 

• 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)  

8. 24-01 Continuing Demonstration Project on Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means - March, 5, 2024.

9.  25-01 Continuing Demonstration Project on Allowing or Requiring Fair Hearing Appearances by Written, Telephonic, Video, or Other Electronic Means 

Pre-Hearing Determinations (PHD) NYS 2025 Fair Hearing Compliance Plan  

See our NYHA article, 2025 Medicaid Fair Hearing Compliance Plan = "Pre-Hearing Dispositions" or PHD's.

For more information about Fair Hearings - including Pro Se Resources 

• Legal Services NYC Video Series on Fair Hearings 

• New Pro Se Online Resource  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.