Pursuant to 42 U.S.C. § 1396 et seq., 42 C.F.R. § 430.0 et seq., LAC 50:III.101 et seq., and Louisiana’s Medicaid Eligibility Manual (T-0000), every applicant for and enrollee of Louisiana Medicaid benefits, has the right to appeal any action or decision by LDH, and has the right to a fair hearing in the presence of an impartial hearing officer at DAL. Agency action is defined as "a termination, suspension or reduction of Medicaid eligibility or covered services." DAL provides an impartial hearing officer who assures LDH has correctly applied federal and/or state law. Applicants/recipients must timely request a fair hearing, typically within 30 days of the date of the decision notice issued by LDH. Please review the notice from LDH for information on requesting a hearing and retaining benefits pending the hearing.
To request a recipient/applicant fair hearing, please submit a Recipient/Applicant Appeal Request Form online or mail a request to: Division of Administrative Law, ATTN: HH Section, P.O. Box 4189, Baton Rouge, LA 70821. The request may also be faxed to (225) 219-9823.
If you missed your hearing and received a Conditional Order of Dismissal and would like to have another hearing scheduled please submit a Response to Conditional Order of Dismissal Form.
Medicaid Involuntary Discharges
An administrative appeal may be requested from a proposed involuntary transfer or discharge of a client from a nursing facility, intermediate care facility, adult residential care facility, or home and community based services provider. A recipient, or someone acting on his/her behalf, has the right to appeal a facility's decision to discharge. Please review the notice from LDH for information on requesting a hearing.
To request a fair hearing regarding a Medicaid involuntary discharge, please submit a Recipient/Applicant Appeal Request Form online or mail a request to: Division of Administrative Law - HH Section, P.O. Box 4189, Baton Rouge, LA 70821. The request may also be faxed to (225) 219-9823.
If you missed your hearing and received a Conditional Order of Dismissal and would like to have another hearing scheduled please submit a Response to Conditional Order of Dismissal Form.
Medicaid Provider Hearings
A Medicaid provider that has received a notice of sanctions (e.g. recoupment, recovery, suspension, exclusion), or that has received notice that a facility license or certification has been denied, has the right to request an administrative appeal of LDH’s decision.
To request a provider appeal, please submit a Provider Appeal Request Form online or mail a request to: Division of Administrative Law - HH Section, P.O. Box 4189, Baton Rouge, LA 70821. The request may also be faxed to (225) 219-9823.
DSW, CNA, and MAC Hearings
Pursuant to LAC 48:I.9273, LAC 48:I.9285, LAC 48:I.10071, and LAC 48:I.10089, DAL conducts administrative hearings regarding the review, investigation, and appeal of all allegations of wrong-doing by direct service workers, certified nursing aides and nurse aide trainees, and certified medication attendants. When there are substantiated allegations against these workers, either through oral or written evidence, LDH will notify the worker(s) implicated in the investigation. The workers(s) must appeal LDH's notice of violation or notice of the results of an informal dispute resolution, within 30 calendar days after receipt of LDH's notice. The request for an administrative hearing must be made in writing to DAL and shall contain a statement setting forth the specific allegations which the worker disputes and the reasons for the dispute.
LDH’s Office of Public Health Sanitarian Services, is responsible for enforcing the Louisiana Sanitary Code (LAC 51:I.101 et seq.). DAL conducts hearings concerning violations and sanctions of the Sanitary Code.
Women, Infants, and Children (WIC) Program is a special supplemental nutrition program for pregnant, breastfeeding, and postpartum women; infants; and children under five years old. LDH’s Office of Public Health (OPH) administers the Louisiana WIC Program. Pursuant to 7 C.F.R. § 246.9, any household aggrieved by any action of LDH which affects participation of the household in this program is entitled to a fair hearing at DAL. Pursuant to LAC 48:V.4511, WIC participants who are denied participation or are disqualified from program participation may submit a timely appeal, typically within 60 days of the date of notice from LDH.
Also, pursuant to LAC 45:V.4511, adverse actions taken by the WIC program that affect vendors/vendor applicants may be subject to administrative review, if appealed. If a WIC authorized vendor/applicant vendor wishes to appeal any decision, the vendor/applicant vendor shall submit a request for appeal stating the reason for the appeal. The request shall be submitted in writing and mailed to the Louisiana WIC Program within 15 calendar days after receipt of LDH’s notification of adverse action.