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Hearing Rights and Responsibilities in Medicaid Cases

The Applicant and DFCS have the right to the following:

1. Bring and/or subpoena witnesses;
2. Establish all pertinent facts and circumstances;
3. Present arguments without undue interference;
4. Question or refute any testimony or evidence, including the opportunity to question and cross-examine adverse witnesses.

42 C.F.R. § 431.242(b) through (e).

DFCS has the responsibility for the following:

1. Ensuring the presence at the hearing of staff members with direct knowledge of the facts in dispute;
2. Ensuring that all relevant agency records and copies are legible and available as evidence;
3. Ensuring that non-agency witnesses and records are present, either voluntarily or by subpoena.

See Appendix B-5.

If the applicant’s prima facie case supports eligibility, then the Department must present evidence rebutting the applicant’s case.

If the hearing involves an issue of eligibility and the Medicaid agency is not responsible for eligibility determinations, the agency that is responsible for determining eligibility must participate in the hearing. 42 C.F.R. § 431.243.

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