Recipient appeals are filed by applicants or recipients of cash assistance, medical assistance, food stamps, and other DHS or Department of Aging benefits and services. The hearing proceedings and the processing and adjudication (deciding) of appeals are governed by regulations at 55 Pa. Code Chapter 275 (as well as 6 Pa. Code, Chapter 3 for Aging appeals).
When the Department of Human Services (DHS) or the Department of Aging notifies the applicant or recipient that benefits or payments have been denied or will be reduced, suspended or terminated, he or she has the right to request a fair hearing to dispute the adverse action. Appeals must be filed in written format, except in Supplemental Nutritional Assistance Program (SNAP), formerly Food Stamp, cases. An oral appeal can be filed to dispute an adverse action regarding SNAP benefits.
The Bureau of Hearings and Appeals conducts the fair hearings and decides the DHS applicant and recipient appeals and the appeals from Department of Aging adverse actions. The Bureau currently receives approximately 100,000 appeals per year. Appeals are filed with program offices, which process and track them, then forward them to BHA. Appeals must be forwarded to the Bureau within three workdays of receipt by the program offices.
When an appeal is received by the Bureau, it is docketed and scheduled for a hearing to be conducted by an Administrative Law Judge. When a hearing date has been assigned, a written notice is sent to both parties, i.e. the appellant and to the departmental program office. In appropriate cases, DHS' Office of General Counsel (OGC) is also notified of the hearing.
Hearings may be conducted over-the-telephone or in person. Most recipient cases are handled via telephone. In Philadelphia, more of the hearings are held in person, i.e., the appellant and the DHS' representative travel to the regional Bureau office and the hearing is conducted by the Administrative Law Judge with the parties present. Hearing method (telephone or in person) is the appellant's preference. Appellants may choose four options for the hearing:
A. Telephone Hearing – The ALJ will call all parties involved in the case.
B. Telephone Hearing From the Program Office/CAO – The ALJ will call the Program Office or CAO with the both the Appellant and the Department present by phone at the Program Office/CAO location.
C. Face-to-Face Hearing – All parties are present at one of the six areas in Pennsylvania (Erie, Pittsburgh, Harrisburg, Reading, Pittston, or Philadelphia) depending on where the Appellant lives.
D. Face-to-Face Hearing – Program Office/CAO present by Phone – The ALJ and the Appellant will have a face-to-face hearing in the courtroom, and allow the representative for the program office/CAO to remain at their office location.
Whether in person or over-the-telephone, hearings are conducted in accordance with 55 Pa. Code, Chapter 275 (also 6 Pa. Code, Chapter 6 in Aging appeals).
The responsibilities of the Administrative Law Judge include conducting the hearing in an orderly but informal manner and obtaining testimony and documentary evidence from the parties. The Administrative Law Judge may choose to make an oral decision on the appeal at the hearing. The oral decision at the hearing is called a bench decision. If the Administrative Law Judge decides the appeal with a bench decision, the Administrative Law Judge will issue a short written decision. If the Administrative Law Judge does not choose to issue a bench decision, the Administrative Law Judge prepares a written decision (adjudication) based upon the facts and evidence. The decision or recommendation contains a statement of the issues, findings of fact, a discussion and a ruling of the Administrative Law Judge. The adjudication of a DHS applicant or recipient appeal is then subject to review by the Director of the Bureau and can be affirmed, amended, reversed or remanded.
In a Department of Aging appeal, the Administrative Law Judge writes an adjudication in the form of a proposed report to the Secretary of the Department of Aging (or Chief Counsel Designee). The Secretary of Aging or Chief Counsel designee may accept the proposed report immediately or issue it to the parties to file exceptions to (i.e. arguments against) the proposed report. The parties have 30 days to submit any exceptions. At the end of the 30 days, the Secretary of Aging or Chief Counsel designee will issue a Final Order to accept the proposed report or reverse it.
Either party to an appeal (unless the issue under appeal is SNAP related) may seek reconsideration by the Secretary of Human Services from the final order of the Director of the Bureau by requesting such within 15 calendar days from the date of the final order. If the issue under appeal is SNAP related, only the applicant or recipient may request reconsideration. Additionally, the parties have the right to seek review by the Commonwealth Court of Pennsylvania of any decision by the Director of BHA.
The parties may seek reconsideration and petition Commonwealth Court simultaneously. If a party elects to request reconsideration only, his or her right to petition Commonwealth Court is still preserved pending the Secretary's decision on reconsideration.
Should the Secretary find in favor of the appellant, the appropriate party(ies), where permitted, may take issue with the adjudication and Order, and may petition the Commonwealth Court of Pennsylvania within 30 days from the date of the order. However, if the Secretary finds for DHS, the appellant may seek review before the Commonwealth Court of Pennsylvania. If Commonwealth Court review is sought, the DHS' legal counsel represents the program office or agency involved in the dispute. A petition to Commonwealth Court must be filed with the Clerk of Commonwealth Court of Pennsylvania, 601 Commonwealth Avenue, Suite 2100, P.O. Box 69185, Harrisburg, PA 17106-9185.