Benefits denied? How to appeal Medicaid, TANF, SSI, unemployment and more

Agencies must send written notice of adverse decisions with reasons and appeal rights. The notice is the key document - keep it and the envelope.

Medicaid, CHIP and TANF use state fair hearings before impartial officers. Requesting quickly can preserve benefits pending the decision. Social Security programmes (SSI, SSDI) use reconsideration, then a hearing before an administrative law judge. Unemployment appeals go to a state appeals body with short deadlines.

Evidence matters: documents, witness statements, medical records, proof of sent paperwork. You can review your case file.

Many denials are procedural - missing documents or interviews - and can be fixed fast by reapplying or submitting what is missing alongside an appeal.

Legal aid offices handle benefits appeals regularly and often win.

Most adverse decisions fall into a few patterns. Procedural denials happen when an interview was missed, a form was not returned, or documents did not arrive. Eligibility denials happen when the agency decides your income, resources, household or circumstances do not meet the rules. Calculation errors happen when you are approved but for the wrong amount, often because income was counted twice, an expense was left out, or a household member was added or removed incorrectly. Knowing which pattern fits tells you whether to reapply, correct the record, or argue the rules at a hearing.

Many programmes let you continue receiving benefits while an appeal is pending if you request it quickly - typically within ten days of the notice or before the effective date of the change. This is often called aid paid pending or continuing benefits. If you ultimately lose, you may be asked to repay the benefits received during the appeal, so legal aid can help you weigh the decision. If you win, benefits you should have received are restored.

Hearings are less formal than a court case but they are still legal proceedings. The agency presents its reasons; you explain what was wrong and show evidence; the hearing officer can ask questions of both sides. Bring copies of everything, arrange for witnesses if helpful, and ask for an interpreter or disability accommodation in advance. Many hearings are by telephone, so make sure you can take a call privately at the scheduled time.

Check each programme's specific rules on your notice.

1. Read the notice

   Reason and deadline.

2. Request the appeal in writing

   Before deadline.

3. Ask to keep benefits

   If applicable.

4. Gather evidence

   And review your file.

5. Get legal aid

   Free help.

6. Attend the hearing

   By phone or in person.

7. Reapply if faster

   For procedural denials.

Adverse action

Any decision that denies, reduces, suspends or ends your benefits.

Fair hearing

A formal review by an impartial hearing officer of a state benefits decision, used for Medicaid, CHIP, TANF and others.

Reconsideration

The first stage of appeal for Social Security programmes such as SSI and SSDI, reviewed by someone who did not make the original decision.

Aid paid pending

Continuing benefits while your appeal is decided, available in many programmes if you appeal quickly.

Procedural denial

A denial for a missing step - interview, form or document - rather than ineligibility.

Administrative law judge (ALJ)

A judge who conducts hearings for Social Security and some other agencies.

• Find free legal aid (LSC)www.lsc.gov
• Social Security Administrationwww.ssa.gov