1. (1)(a) The Department has been designated by the Utah Department of Health and Human Services to determine eligibility for medical assistance, as authorized by the following:

   1. (i) 42 U.S.C. 1396a;

      1. (ii) 42 C.F.R. 431.10;
      2. (iii) Section 26-18-5 of the Utah Code; and
      3. (iv) Section R414-301-2.
   2. (b) The Department of Health and Human Services administers Medicaid and other medical assistance benefits programs.

2. (2)(a) An adversely affected party may request a fair hearing to review a decision of medical assistance eligibility.

   1. (b) Except as stated in this rule, a fair hearing request follows the procedures of Sections R986-100-123 through R986-100-135.

3. (3) A hearing may be requested by:

   1. (a) a client;
   2. (b) a client's spouse;
   3. (c) a parent or guardian of a minor client; or
   4. (d) an authorized guardian or representative of a client.

4. (4)(a) A representative from DWS shall participate in hearings.

   1. (b) Representatives from other state agencies may participate as needed.

5. (5)(a) If the ALJ or hearing officer's decision is not appealed for agency review as provided in Section R986-100-138, the decision becomes final 30 days after the decision is issued.

   1. (b) The parties may stipulate to an earlier effective date, if no appeal will be requested.
   2. (c) If the ALJ or hearing officer reverses the eligibility decision, the Department of Health and Human Services will comply with the ALJ or hearing officer's decision after the decision becomes final.

6. (6)(a)(i) A recipient of medical assistance benefits may continue to receive benefits pending a hearing decision if the recipient requests the hearing before the effective date of the eligibility determination or within 15 days on the notice of eligibility determination.

   1. (b) A recipient may decline the continued benefits while a hearing is pending by notifying the Department of Health and Human Services in writing.
   2. (c) A recipient must repay any benefits received while a hearing is pending if a decision denying eligibility is upheld.

KEY: employment support procedures, hearing procedures, public assistance, SNAP

Date of Last Change: December 29, 2022

Notice of Continuation: August 14, 2025

Authorizing, and Implemented or Interpreted Law: 35A-3-101 et seq.; 35A-3-301 et seq.; 35A-3-401 et seq.