Representing yourself at an administrative hearing

Yes. You should read this if you get, or have applied for, benefits through the Department of Social and Health Services (DSHS), or Medicaid (Apple Health) through the Health Care Authority (HCA), and you disagree with a verbal or written decision the agency has made about your benefits. We explain here how you can appeal that decision by asking for and going to an administrative hearing. WAC 388-02-0085 (DSHS); WAC 182-526-0085 (HCA).

You will learn:

• When and to ask for a hearing.
• How to get ready for your hearing.
• What happens at the hearing and afterward.

If you have a hard time speaking or understanding English, or cannot communicate in spoken language, you have the right to a qualified and impartial interpreter at no cost.  WAC 388-02-0120 (DSHS); WAC 182-526-0120 (HCA). Family members and friends cannot be your interpreter at the hearing.  

DSHS cases: To ask for an interpreter, talk to the Administrative Coordinator at your local DSHS office, or call the Office of Administrative Hearings (OAH) at (360) 664-2700 or 1-800-583-8271. Tell them you need an interpreter.

HCA cases: Fill out any form that came with your letter and fax it to 1-360-586-9080. Or you can call 1-855-923-4633 or 1-800-562-3022 to make the request by phone.

Both DSHS and HCA cases: The agency must give you a written notice if it plans to turn down (deny), lower, or stop (terminate) your benefits, sanction (punish) you, or decide it paid you too much (overpaid you) benefits or gave you benefits they agency later determines you did not actually qualify for. WAC 388-458-0002 (DSHS); WAC 182-518-0005 (HCA). You can ask for an administrative hearing anytime within 90 days of the date of the agency's notice.

The notice the agency gives you must say both of these:

• What action the agency is taking.
• What rule or rules it is relying on.

If you get benefits, and you ask for a hearing within ten days of the date on the notice or before the date the agency says it will stop or lower your benefits, the agency must keep giving you benefits until an ALJ has decided your case. If the agency stops your benefits without giving you written notice, ask for an administrative hearing to ask for con­tinued benefits.

If the agency is stopping or paying you less benefits, any continued benefits you get may become an overpayment -- a debt you owe the agency -- if you lose your hearing. You might have to repay up to 60 days of benefits. Read How to Fight an Overpayment of Cash or Medical Assistance  and Fighting a Food Assistance Overpayment to learn more about how the agencies collect overpayments.

There are different ways you can do this.

In writing: Write the Office of Administrative Hearings (OAH), P.O. Box 42488, Olympia, WA 98504.

Verbally: You can call OAH or tell the agency representative that you want a hearing. The agency may have you follow up with a written request.

After you ask for a hearing, OAH will mail you a "Notice of Hearing" saying the hearing time, date, and place.

Call OAH as soon as you can at the number on the notice to ask for an in-person hearing. In-person is usually better.

DSHS cases: You have the right to have the hearing at your local DSHS Community Services Office (CSO). You can visit dshs.wa.gov/office-locations to find the CSO nearest you.

HCA cases: You can ask for an in-person hearing. You will need to have a good reason for your request. See WAC 182-526-0360 for some examples of good reasons.

You can make an appointment to meet with an agency representative. This representative usually not a lawyer. They will represent the agency at your hearing.

Ask the agency representative:

• To explain why the agency is denying, changing, or stopping your benefits, or taking any other action against you.
• To give you copies of all rules the agency is using to support its action.
• To ask if the agency will have witnesses at the hearing. If so, ask who, and what the agency representative will ask them about.
• To view and get copies of relevant documents from your electronic case file.

This is a chance to understand the issues better from both sides and help you get ready for your hearing. You may even be able to settle the case. If you don't settle, you will still have the hearing. The agency representative should not pressure you to cancel (withdraw) your hearing request.

Well before your hearing, the agency should give you a packet of all documents they will use at the hearing. If you do not get the packet by a week before the hearing, call the agency representative. If you believe the agency gave you the packet too late for you to review and understand, ask the ALJ to reschedule the hearing or take some other action to be fair to you because you did not get the packet in time to get ready.

Before your hearing, you should send the judge at OAH and the agency representative at the agency identical copies of all documents, pictures, and other papers you will use at the hearing to show why you think the agency is wrong. Most hearings are by phone. The judge and the agency representative need to have gotten your documents in time for your hearing.  You should send them in beforehand even if your hearing is in-person. Ask OAH and the DSHS rep how they want you to send documents in. Always keep the original for yourself.

It is like a pre-hearing meeting, but it takes place on the record. This means that the ALJ is there, and records it.

• A written list of points you want to explain to the ALJ.
• Any documents, pictures, or other papers showing why you think DSHS is wrong.
• Witnesses to testify on your behalf.
• A friend or relative to support you. They do not have to testify.
• A friend, relative, or other person to represent you at the hearing. They do not have to be a lawyer.

The ALJ conducts the hearing. The ALJ works for OAH.

These hearings have fewer rules (are less formal) than court proceedings. The ALJ records it and takes notes.

At the start of the hearing, the ALJ will explain that the ALJ does not work for DSHS, has never seen your file, and knows nothing about you or the case except what your hearing request said.

The ALJ explains that in deciding your case, they consider only:

• Documents you and the agency give (submit) to the ALJ.
• Sworn testimony.

The ALJ will swear in everyone who will testify.

Usually, the agency representative talks next. They tell the ALJ why the agency believes it is right, and explain the agency's documents it has given the ALJ to prove its case (its exhibits). When the agency representative finishes, you can ask them about what they said. If the agency representative has witnesses, you can question them when they finish testifying. The ALJ may ask the agency representative and/or witnesses questions to clarify what they have said

Now you tell your side of the story. Remember: All the ALJ knows about you or the case is what your hearing request said. You must tell the ALJ everything you want them to know. Look at your notes. Tell the ALJ exactly what happened from your perspective. When you finish, the agency representative and the ALJ may question you. Then any witnesses you have can testify. The agency representative and ALJ may question your witnesses.

How you act is important. The ALJ hears or sees you just this once.

Some tips:

• Be polite. Do not interrupt anyone.
• Be firm, but do not yell.
• Do not swear or use other offensive language.
• Look at the ALJ while you speak.
• Do not roll your eyes or use other disrespectful or offensive gestures.
• Dress neatly.

For more tips, read Coronavirus (COVID-19): Tips for Phone and Video Hearings. The advice there works for in-person hearings, too.

The ALJ does not decide at the hearing. They mail you a written decision about a month after. It is either an Initial Order or a Final Order. There is an important difference. See the next question, "I got an Initial Order. Can I appeal it if I disagree with it?"

If you or the agency disagree with the Initial Order, you can appeal to a Review Judge who works for the agency's Board of Appeals (BOA). This appeal is a Petition for Review. Instructions on petitioning for review and the deadline come with the Initial Order.

This appeal is in writing only. You do not go before the Review Judge. The Review Judge considers only documents and testimony from the hearing. You cannot add anything. If you send the BOA a written appeal, DSHS can respond in writing. If DSHS appeals to the BOA, you can respond.

The Review Judge will send you and the agency a Review Decision. If you disagree with it, state law permits you to file a Petition for Review of Administrative Decision to your county Superior Court or Thurston County Superior Court. If your hearing was about public assistance, there is no fee to file in Superior Court. You must file a Petition of Administrative Decision within 30 days of the date of the Review Decision. If you cannot get a lawyer, read How to Petition for Superior Court Review to learn more.

If your hearing notice has a "B" in the docket number, you get a Final Order. If you or the agency disagree with the ALJ's Final Order, you cannot appeal to the BOA. You can ask the ALJ to reconsider their decision. This is different from asking someone different to review the decision (an appeal).

The ALJ's decision on Reconsideration is the final agency decision. The agency cannot appeal it further. If you disagree with the Reconsideration decision, you appeal by filing a Petition for Review of Administrative Decision.

You can skip the Request for Reconsideration and appeal a Final Order to Superior Court with a Petition for Review of Administrative Decision. Read How to Petition for Superior Court Review to learn more.