Alabama Medicaid Appeals and Fair Hearings

If your Alabama Medicaid coverage was denied, cut, or terminated, you have the right to appeal and request a fair hearing, and in some cases you can keep your benefits while the appeal is decided.1,2 In Alabama, you request that hearing directly from the Alabama Medicaid Agency, and by default a written request must be received within 60 days of the date the notice of action is mailed.3 If you act before your benefits stop, they can continue until a hearing decision is issued.2

In This Guide

• What You Can Appeal in Alabama Medicaid
• The Deadlines That Decide Your Alabama Medicaid Appeal
• How to Keep Your Benefits During the Appeal
• Managed Care in Alabama: Why There Is No Plan Appeal First
• How to Request an Alabama Medicaid Fair Hearing
• Frequently Asked Questions
• Learn More

What You Can Appeal in Alabama Medicaid

Federal law gives Medicaid applicants and beneficiaries the right to a fair hearing before the state agency. Section 1902(a)(3) of the Social Security Act (42 USC 1396a(a)(3)) requires Alabama's Medicaid plan to provide an opportunity for a fair hearing to anyone whose claim for medical assistance is denied or is not acted upon with reasonable promptness. The implementing regulation at 42 CFR 431.220 requires the agency to grant a hearing to anyone who believes it acted erroneously or denied a claim for eligibility or covered services, and to several other groups, including a nursing facility resident who believes the facility wrongly decided to transfer or discharge them. The federal regulation states one limit: the agency need not grant a hearing if the sole issue is a federal or state law requiring an automatic change that adversely affects some or all beneficiaries.1

In Alabama, the fair hearing right reaches any agency action or policy affecting your receipt of medical assistance.3 That includes:

• A denial of your application for Medicaid coverage
• A termination or reduction of your eligibility or a covered service
• A denial of payment for a service you received
• A prior authorization or level of care determination you disagree with
• A claim that was not acted upon with reasonable promptness

One limit is worth knowing up front. Alabama Medicaid eligibility is often based on determinations made by another agency, such as the Department of Human Resources (DHR) or the Social Security Administration (SSA). When your complaint concerns one of those underlying eligibility determinations, Alabama refers the matter to the agency that made the determination for a hearing rather than deciding it inside the Medicaid Agency.3

Alabama's own rules also say when a hearing may be refused. A request may be denied if, in the opinion of Medicaid legal counsel, it presents only a legal issue and does not challenge the validity of the controlling law or regulation, and no fair hearing need be given when eligibility was ended because of a criminal conviction for Medicaid fraud or abuse.3

The Deadlines That Decide Your Alabama Medicaid Appeal

Two windows decide most Alabama Medicaid appeals, and they are not the same number. Unless another rule, waiver, or statute sets a different timeframe, you have 60 days to request a fair hearing. When Medicaid is ending your eligibility, you have only 10 days to keep your benefits flowing while it is decided.3

Under the Alabama Medicaid Administrative Code (560-X-3-.03), a written request for a fair hearing must be received by Medicaid within 60 days from the date the notice of action is mailed, unless a different timeframe is prescribed elsewhere by rule, waiver, or statute, and the agency will not accept requests received outside the allotted timeframe.3 Federal law caps this window at 90 days from the mailing date and lets a state set a shorter operational deadline, which is what Alabama's 60-day default rule does.3 The deadline that governs you is the one printed on your own notice of action, so read it there rather than assuming 90 days.3

If Medicaid is ending your eligibility and you want your benefits to keep flowing while the appeal is decided, a much shorter deadline applies: your fair hearing request must reach the Alabama Medicaid Agency within 10 days of the notice date, not the full 60-day default window.3 The next section explains how that continuation works.

Once your case is filed, Alabama also runs a clock on itself. Final administrative action on a fair hearing is to be taken within 60 days of the hearing request unless extenuating circumstances require more time, in which case you are to be told the reason for the delay, and in any event within 90 days of the request.3

One separate rule can spare you an appeal entirely. If your coverage ended only because you did not return a renewal form or requested information on time, and your eligibility is based on modified adjusted gross income (MAGI), federal law requires the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days after the termination date. If you qualify through SSI or another pathway that needs no income determination by the agency, or through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Alabama may offer that same 90-day reconsideration but federal law does not require it, so ask the Agency.4 Either way it is a reconsideration, not a fair hearing, and it does not require you to argue the agency was wrong.

How to Keep Your Benefits During the Appeal

Keeping your benefits during an appeal is called aid paid pending, and in Alabama, when Medicaid is ending your eligibility, it turns on acting within the 10-day window rather than the 60-day default window for requesting a hearing.3

Under 42 CFR 431.230(a), if the agency sent the required advance notice and you request a hearing before the date the action takes effect, the agency may not terminate or reduce your services until a decision is rendered after the hearing.2 That protection has one narrow exception, and it takes both halves: the hearing must determine that the sole issue is one of federal or state law or policy rather than the facts of your case, and the agency must promptly tell you in writing that your services are to be terminated or reduced pending the hearing decision.2

Alabama's own rule sets a 10-day window, and it names 42 CFR Part 431, Subpart E, the federal subpart that holds that continuation rule, among its statutory authority. In a case where Medicaid is terminating your eligibility, if your fair hearing request is received within 10 days of the date of the notice of action, your benefits may be continued pending the outcome of the hearing, unless you or your representative cause unnecessary delay in finishing it.3

When a termination notice arrives, do not wait out the full 60-day default appeal window if you need your coverage to continue. Get your hearing request to the Alabama Medicaid Agency within 10 days of the notice date. If the notice reduces a service instead, request the hearing before the date the change takes effect. Don't assume continuation happens on its own: ask for it explicitly when you file.2

Managed Care in Alabama: Why There Is No Plan Appeal First

Under the federal managed care rules, a Medicaid member enrolled in a managed care plan generally may request a state fair hearing only after the plan has upheld its own denial on an internal appeal.5 Alabama's own fair hearing rules read differently.

Alabama's long-term-care managed care program is the Integrated Care Network (ICN), which Alabama Medicaid describes as a competitively bid, integrated network providing enhanced case management, education, and outreach services to most Medicaid long-term care beneficiaries in both home and community-based services (HCBS) and institutional settings. CMS approved it on September 12, 2018, and it supports the Primary Care Case Management (PCCM) Entity model.3

Alabama's fair hearing chapter in the Administrative Code sets out no plan-level internal appeal you must exhaust before a fair hearing. When you disagree with an agency action, you request the fair hearing directly from the Alabama Medicaid Agency.3 Under those rules, that is one request, to one agency. Another program could still set its own step, so also follow any appeal instructions printed on the notice you received.3

How to Request an Alabama Medicaid Fair Hearing

You or your authorized representative can request a fair hearing, and the request must be received by the Alabama Medicaid Agency within the filing window, 60 days by default.3 Under a rule that took effect July 13, 2026, the request must include the name of the person whose case it is (and, if someone else is asking, that person's name too), and it may only be submitted in one of three ways:3

• By mail: to the district office handling your case, or to the central office at Alabama Medicaid Agency, Attn: Fair Hearings Coordinator, 501 Dexter Avenue, Post Office Box 5624, Montgomery, Alabama 36103-5624. It counts as received the date it is delivered to that office.3
• By e-mail: to FairHearings@medicaid.alabama.gov. It counts as received the date the e-mail reaches the agency's inbox.3
• By phone: by reaching your Medicaid case worker or the Fair Hearings Coordinator at 334-353-5210. It counts as received the date the case worker or Coordinator documents your request, and requests left by voicemail are not accepted.3

To speed things up, send a copy of the action letter you are appealing and a statement of the issues you are appealing, and if you are filing for someone else, documentation showing your authority to act for them.3

Once the agency has your request, it decides your case one of two ways. A face-to-face hearing is held before an impartial state hearing officer, or a documentary hearing is decided solely on the written or printed evidence both sides submit, with the same authority as a face-to-face hearing. If you want a documentary hearing, send your complete records with your original request.3 The Hearing Authority for all recipient fair hearings is the Commissioner of the Alabama Medicaid Agency, who appoints one or more impartial hearing officers to conduct the hearing and recommend a decision. A hearing officer who was involved in the action you are challenging cannot decide your case.3

If the final decision goes against you, it is not necessarily the end. An adverse decision approved by the Commissioner states that a rehearing or judicial review is available under the Alabama Administrative Procedure Act (APA).3

Learn More

Find personalized help navigating an Alabama Medicaid appeal at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.