Ala. Admin. Code r. 420-10-2-.07

Current through Register Vol. 43, No. 02, November 27, 2024

Section 420-10-2-.07 - Appeal Procedures For Participants

(1)Availability of hearings. The Department shall provide a hearing procedure through which any individual may appeal a state or local agency action that:

(a) Results in a claim against the individual for repayment of the cash value of improperly issued benefits.

(b) Results in the individual's denial of participation in the Alabama WIC Program

(c) Results in the individual's disqualification from the Alabama WIC Program.

(2)Informal resolution of adverse action. The aggrieved individual should discuss his or her problem with a staff member of the county health department, WIC clinic, area office, or State WIC Program prior to requesting a formal hearing. Staff members at the local clinic, area office, or State WIC Program may not limit or interfere with a person's right to request an appeal hearing.

(3)Notification of appeal rights. At the time of a claim against an individual for improperly issued benefits or at the time of participation denial or of disqualification from the WIC Program, the Department shall inform the individual in writing of the right to a fair hearing, of the method by which a hearing may be requested, and that any positions or arguments on behalf of the individual may be presented personally or by a representative such as a relative, friend, legal counsel, or other spokesperson. This notification is not required at the expiration of a certification period. Notification is required at:

(a) Time of Application, Income. When an applicant's income exceeds the maximum allowed for the WIC Program, the applicant must be informed of his ineligibility and how an appeal may be requested using the WIC Notification Form, ADPH-WIC-119.

(b) Time of Application, Medical Assessment. If after screening, the applicant does not meet the medical requirements for participation in the WIC Program, the applicant must be informed of his ineligibility and how an appeal may be requested using the WIC Notification Form, ADPH-WIC-119.

(c) Termination from the WIC Program. When terminating a participant from the WIC Program, the participant must be informed of how to request an appeal. Use the WIC Notification Form, ADPH-WIC-119, when removing a participant between certification or a time of categorical ineligibility. Except for a participant who will be disqualified for not picking up cash-value vouchers, supplemental foods, or food instruments in accordance with 7 CFR § 246.7(h)(3)(i), the client must receive 15 days advance notice of this adverse action.

(d) Suspension from the Program. Suspension shall be done through formal written notification. Except for a participant who will be disqualified for not picking up cash-value vouchers, supplemental foods, or food instruments in accordance with 7 CFR § 246.7(h)(3)(i), the client must receive 15 days advance notice of this adverse action.

(e) Denial of Participation. Use the WIC Notification Form ADPH-WIC-119 at certification attempt to inform the applicant why he or she is not being allowed to participate and how an appeal may be requested.

(4)Request for hearing. An individual may request an appeal hearing by contacting any staff member in the county health department, WIC clinic, area office, or the WIC director. A request may be made by any clear verbal or written expression. If the request is made verbally, a staff member will assist in reducing the request to writing so that a record is available. Written appeal hearing requests must be sent to the following address: Alabama Department of Public Health; Bureau of Family Health Services; Division of WIC; The RSA Tower, Suite 1300; P.O. Box 303017; Montgomery, AL 36130-3017.

(5)Time limit for request. A request for a hearing must be made within 60 days from the date of the receipt of the notification of the adverse action.

(6)Acknowledgment of request. The Division of WIC shall provide written acknowledgment of the receipt of the request for an appeal hearing within ten days from the date the request is received.

(7)Notice of hearing. The person requesting an appeal hearing must receive at least ten days advance written notice of the time and place of the formal hearing.

(8)Scheduling the hearing. The Department shall schedule a hearing within 21 calendar days from the date the request is first received unless that time period is waived by the aggrieved party. The place of the hearing must be accessible to the appellant.

(9)Hearing decision. Within 45 days of the receipt of the request for the hearing, unless this time period is waived by appellant, the Department shall notify the appellant or his or her representative in writing of the decision and the reasons for the decision.

(a) If the decision is in favor of the appellant and benefits were denied or discontinued, benefits must resume immediately.

(b) If the decision concerns disqualification and is in favor of the Department, as soon as administratively feasible, the continued benefits terminate, as decided by the hearing official.

(c) If the decision regarding repayment of benefits by the appellant is in favor of the Department, the Department shall resume its efforts to collect the claim.

(d) Time frames established for issuing review decisions are only administrative requirements and do not provide a basis for overturning the adverse action if a decision is not rendered within the specified time period. The decision of the hearing official is the final state agency action.

(10)Denial or dismissal of request. The State may deny or dismiss a request for a hearing if:

(a) The request is not received within the time limit set by the Department.

(b) The appellant or a representative of the appellant withdraws the request in writing.

(c) The appellant or representative fails, without good cause, to appear at the scheduled hearing.

(d) The appellant has been denied participation by a previous hearing and cannot provide evidence that circumstances relevant to WIC Program eligibility have changed in such a way as to justify a hearing.

(11) Continuation of benefits.

(a) Except for participants whose certification period has expired, participants who appeal the termination of benefits within the 15 days advance adverse notice period provided by 7 CFR § 246.7(j)(6) must continue to receive WIC Program benefits until the hearing official reaches a decision or the certification period expires, whichever occurs first.

(b) Applicants who are denied benefits at initial certification or because of the expiration of their certification may appeal the denial but may not receive benefits while awaiting the hearing.

Ala. Admin. Code r. 420-10-2-.07

New Rule: Filed October 24, 1995; effective November 28, 1995. Repealed and New Rule: Filed October 20, 1999; effective November 24, 1999. Repealed and New Rule: Filed November 20, 2003; effective December 25, 2003. Repealed and New Rule: Filed August 20, 2004; effective September 24, 2004. Amended: Filed May 17, 2013; effective June 20, 2013.

Adopted by Alabama Administrative Monthly Volume XXXVI, Issue No. 07, April 30, 2018, eff. 5/28/2018.

Authors: James M. Richard, Carolyn Battle, Stacey Neumann

Statutory Authority:Code of Ala. 1975, §§ 22-2-2(6), 22-12c-2 and 3.