{"data":{"id":"us-va/12vac30-110-90","jurisdiction":"us-va","citation":"12VAC30-110-90","heading":"Right to appeal","body":"An individual has the right to file an appeal when:\n\n1. His application for benefits administered by the department is denied. However, if an application for State and Local Hospitalization coverage is denied because of a lack of funds which is confirmed by the hearing officer, there is no right to appeal;\n\n2. The agency takes action or proposes to take action that will adversely affect, reduce, or terminate his receipt of benefits;\n\n3. His request for a particular medical service is denied, suspended, reduced, or terminated, in whole or in part;\n\n4. The agency fails to take an application and/or fails to act with reasonable promptness on his application for benefits or request for a particular medical service;\n\n5. The agency takes action or proposes to take action regarding the recovery of applicable medical assistance payments from a decedent's estate;\n\n6. The agency takes action or proposes to take action regarding the recovery of expenditures for services received by ineligible individuals;\n\n7. The agency takes action or proposes to take action regarding the recovery of expenditures paid on behalf of individuals whose coverage was continued during the appeals process; or\n\n8. Federal regulations require that a fair hearing be granted.","path":["Title 12. Health","Agency 30. Department of Medical Assistance Services","Chapter 110. Eligibility and Appeals","Part I. Client Appeals Subpart I General","Article 4. Notice and Appeal Rights"],"source_url":"https://law.lis.virginia.gov/admincode/title12/agency30/chapter110/section90/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:51:03Z","sha256":"35a317e99886eb5cac82bb1ee445d6773bd194e4e4ce85d91c5b8cc3b47642df","source_id":"us-va-vac","stale":false,"prev":"us-va/12vac30-110-80","next":"us-va/12vac30-110-100"},"notice":"GroundRules: Original legal text. Not legal advice."}