A Medicaid denial is not the final word. You can appeal, and one deadline decides whether your benefits keep flowing while you wait: to keep your current coverage during the appeal, you usually have to request the hearing before the date your coverage is set to change. This guide covers how to appeal a Medicaid denial, from your federal fair-hearing rights and the two deadlines that decide your case to exactly how to act.

In This Guide

You Have the Right to Appeal

Federal law guarantees a fair hearing. Under Section 1902(a)(3) of the Social Security Act and 42 CFR 431.220, every applicant and beneficiary has the right to a hearing before the state agency if their claim for eligibility or covered services is denied, or if the agency doesn't act on it with reasonable promptness. You do not have to do it alone: an authorized representative, such as a family member, an advocate, or a lawyer, can request the hearing and act on your behalf.

This applies to more than an outright denial. You can appeal a termination of coverage, a reduction in services, or a decision you believe the agency got wrong.

The Two Deadlines That Matter

The single most common mistake is confusing two different deadlines. They are not the same, and mixing them up can cost you your benefits.

Deadline 1 is the window to request the hearing at all. Under 42 CFR 431.221(d), the state must give you a reasonable time, not to exceed 90 days from the date the notice of action is mailed, to request a fair hearing. 90 days is the federal ceiling; some states set a shorter operational window for certain decisions, so check the deadline printed on your notice.

Deadline 2 decides whether your benefits keep flowing while you appeal. To keep your current coverage during the appeal, you generally have to request the hearing before the date of action listed on your notice. Miss that earlier date and you can still appeal, but your benefits may stop while the appeal is pending.

The next section explains Deadline 2 in detail, because it is where the whole outcome can turn.

Keeping Your Benefits During the Appeal

This continuation of benefits is called "aid paid pending," and the rule is specific. Under 42 CFR 431.230(a), if the agency sent the required advance notice (generally 10 days, sometimes 5) and you request the hearing before the date of action, the agency may not reduce or terminate your services until a decision is reached after the hearing. The one exception is when the sole issue is a question of federal or state law or policy.

If you miss that date, one narrow option remains. Under 42 CFR 431.231, if you request the hearing no more than 10 days after the date of action, the agency may reinstate your services.

There is a real trade-off to understand before you ask for aid paid pending. Under 42 CFR 431.230(b), if your appeal is later denied, the agency may recover the cost of the benefits it continued solely because of the appeal. So keeping benefits during the appeal protects you if you win, but can leave you owing money if you lose. Weigh that based on how strong your case is.

If You're in a Managed-Care Plan

If you get your Medicaid care through a managed-care plan (an MCO), the path is different: you appeal to the plan first, then to the state.

  • The plan must send you written notice. Under 42 CFR 438.404, the plan must give timely, adequate written notice of any adverse benefit determination, including the reason and your appeal rights.
  • File the plan's internal appeal within 60 days. Under 42 CFR 438.402(c)(2)(ii), you have 60 calendar days from the date on the notice to file an appeal with the plan, and you can do it orally or in writing.
  • The plan must decide on a clock. Under 42 CFR 438.408(b), the plan must resolve a standard appeal within a state timeframe no longer than 30 calendar days, or within 72 hours for an expedited appeal when your health requires speed.
  • Then you can go to the state. Under 42 CFR 438.408(f)(2), once the plan upholds its decision (or fails to meet the rules, which deems the appeal exhausted), the state must give you between 90 and 120 calendar days to request a state fair hearing.

Aid paid pending applies in managed care too: request continuation timely to keep your services while the appeal runs.

How to Request a Fair Hearing

Your denial or termination notice tells you how to request a hearing, usually by mail, phone, or an online portal, and it lists the deadline. To request one:

  • Contact your state Medicaid agency using the method on your notice.
  • Give your name, the notice, and a clear statement that you want a fair hearing.
  • If you want to keep your benefits, say so, and do it before the date of action on the notice.
  • Keep a copy of everything you send and the date you sent it.

After the hearing, the state issues a written decision. Timeframes vary, so ask your state agency how long its decision takes and when to expect it. If you win, the agency must correct its action; if you kept benefits during the appeal and lose, remember the agency may seek to recover that cost.

Frequently Asked Questions

How long do I have to appeal a Medicaid denial?

Up to 90 days from the date your notice was mailed, under federal rules. Some states set a shorter window for certain decisions, so use the deadline printed on your notice. In a managed-care plan, you file the plan's appeal within 60 days first.

Can I keep my Medicaid benefits while I appeal?

Yes, if you act in time. If the agency sent the required advance notice and you request the hearing before the notice's date of action, your benefits continue until a decision. If you lose the appeal, the agency may recover the cost of the benefits it continued.

How do I request a fair hearing?

Follow the instructions on your denial notice, usually mail, phone, or an online portal, and tell your state Medicaid agency clearly that you want a fair hearing. If you want to keep your benefits, say so before the date of action.

What if I'm in a Medicaid managed-care plan?

Appeal to the plan first. You have 60 days from the notice to file the plan's internal appeal; the plan resolves it within 30 days (72 hours if expedited). If the plan upholds its decision, you then have 90 to 120 days to request a state fair hearing.

Can I bring someone to represent me at the hearing?

Yes. An authorized representative, such as a relative, an advocate, or an attorney, can request the fair hearing and act on your behalf.

Learn More

MedicaidMedicaid Appeals and Fair Hearings in GeorgiaHow to appeal a Georgia Medicaid denial, reduction, or termination, keep your benefits during the appeal, exhaust an MCO appeal, and reach an OSAH hearing. MedicaidMedicaid by State: What Varies and Where to CheckMedicaid works differently in every state, from who qualifies to what's covered and how to apply. See what varies and jump to your state's full guide. MedicareHow to Appeal a Medicare DecisionA Medicare denial isn't final. Here's how to appeal one through all five levels, with 2026 deadlines, dollar thresholds, and the fast track for urgent care.
Your next step Facing a Medicaid denial and a deadline? Brevy's care navigator can help you understand your notice and act before the date on it.

Find personalized help understanding your Medicaid options 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.

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