If your Arizona Medicaid was denied, cut, or terminated, you have the right to appeal and request a fair hearing, and if you ask in time you may keep your benefits during the appeal., In Arizona, Medicaid is run by the Arizona Health Care Cost Containment System (AHCCCS), and a member is either enrolled in a contracted AHCCCS health plan or receives benefits fee-for-service. If you are in a health plan, the path to a hearing runs through that plan first.

In This Guide

What you can appeal in Arizona Medicaid

Federal law gives Medicaid applicants and members a right to a fair hearing before the state agency. Section 1902(a)(3) of the Social Security Act requires each state plan to give a hearing to anyone whose claim for medical assistance is denied or is not acted on with reasonable promptness, and the implementing regulation at 42 CFR 431.220 extends that right to anyone who believes the agency acted erroneously, denied a claim for eligibility or covered services, issued a determination of their liability, or did not act with reasonable promptness, as well as to nursing-facility residents who believe they are being wrongly transferred or discharged and to managed care enrollees. The one carve-out: the agency need not grant a hearing when the sole issue is a federal or state law requiring an automatic change that adversely affects some or all beneficiaries.

In practice, that means you can appeal an "action" your health plan or AHCCCS takes against your care. An action is a denial, a reduction, a suspension, or a termination of a service or benefit, or a failure to act on a request in a timely manner. Examples of decisions you can appeal include:

  • An application or eligibility denial
  • A termination or reduction of a covered service, such as a cut in personal care hours
  • A prior authorization denial, or a change in the amount or type of services you receive
  • A denial of payment, or the plan's failure to act within required timeframes

The right reaches across the program, including members in the Arizona Long Term Care System (ALTCS), whose elderly and physically disabled (ALTCS-EPD) members are served by contracted ALTCS-EPD health plans.

The Arizona Medicaid appeal deadlines that decide your case

An Arizona Medicaid appeal is governed by its deadlines, and they are not all the same number.

The request window: 90 days at the outside

Under 42 CFR 431.221(d), the agency must allow a reasonable time, not to exceed 90 days from the date the notice of action is mailed, to request a fair hearing. Read that as a ceiling, not a floor: 90 days is the longest window a state is permitted to give, not an amount of time you are entitled to. A state may set a shorter deadline so long as it is reasonable, and a shorter state deadline is the one that applies to you. This is the rule for a fee-for-service or eligibility decision; a health plan decision runs on the managed care clocks below. Your notice is the document that controls, so read the deadline printed on it and file by that date.

The continuation window: before the action takes effect

This is the earlier, tighter deadline, and it is the one that keeps your benefits flowing. It is covered in the next section.

The managed care windows: 60 days, then 90 to 120 days

If your denial came from a health plan, you have 60 calendar days from the date on the adverse benefit determination notice to file the plan's internal appeal. After the plan resolves that appeal against you, the state must give you no fewer than 90 and no more than 120 calendar days from the date of the plan's notice of resolution to request a State Fair Hearing; the exact number within that band is set by the state.

One more deadline protects renewals. If your coverage was terminated only because you did not return a renewal form or requested information on time, you do not always have to reapply: under 42 CFR 435.916, if your eligibility is based on modified adjusted gross income (MAGI) and you submit the renewal form within 90 days after the termination date, the agency must reconsider your eligibility without a new application. If you receive SSI or qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Arizona may offer that same 90-day reconsideration but federal law does not require it, so ask AHCCCS.

How to keep your benefits during an Arizona Medicaid appeal

Keeping your benefits during an appeal is called aid paid pending. It is not automatic: you have to request it, and you have to request it in time.

The Arizona rule

Your appeal must be filed before the day the reduction, suspension, or termination is to take effect. Where there are fewer than 10 days between the notice date and the effective date on the notice, your request to continue services must be filed within 10 days from the notice date.

The federal rule behind it

Under 42 CFR 431.230(a), if the agency sent the required advance notice and you request the hearing before the date of action, it may not terminate or reduce your services until a decision is rendered after the hearing. The one exception takes both halves: the hearing must determine that the sole issue is one of federal or state law or policy, and the agency must promptly inform you in writing that services are to be terminated or reduced pending the decision. The trigger is the date of action on your notice, not a flat count of days after you receive it.

Missing that date does not end every route. Under 42 CFR 431.231, the agency may reinstate your services if you request a hearing no more than 10 days after the date of action. And if the agency acted without sending the required advance notice, it must reinstate your services and continue them until the hearing decision, as long as you request a hearing within 10 days of receiving the notice of action (counted as 5 days after the date on the notice unless you show it arrived later) and the action did not result from applying federal or state law or policy.

If you continue benefits and lose

If your benefits continue and the action is later upheld at the hearing, you may have to pay for the services you received during the appeal. Federal law permits the agency to recoup the cost of services furnished solely because benefits were continued.

The practical takeaway: when an adverse-action notice arrives, find the effective date on it, file your appeal before that date, and put your request to continue benefits in writing.

Managed care (MCO) appeals: exhaust your health plan first

Members enrolled in a contracted AHCCCS health plan, which includes elderly and physically disabled members in ALTCS-EPD, get their care through that managed care organization (MCO), the health plan that manages your benefits. When the plan takes an action you disagree with, you appeal to the plan before you can reach a State Fair Hearing. These rules come from the federal managed care regulations at 42 CFR Part 438.

Who your plan is

For the ALTCS Elderly and/or Physically Disabled (EPD) program, which serves long-term-care members, AHCCCS extended its existing contracts with UnitedHealthcare Community Plan, Banner-University Family Care, and Mercy Care from October 1, 2025 through September 30, 2026, and its contract-amendments list shows a further amendment for each of the same three plans, effective October 1, 2026. Detailed instructions for reaching your plan's Grievance and Appeals Department are in its member handbook. Which plans you can choose has depended on where in Arizona you live, so confirm the plans available in your area with ALTCS Member Services at 1-888-621-6880.

What counts as a plan action

Under 42 CFR 438.404, the plan must give you timely, written notice of an adverse benefit determination, which includes a denial or limited authorization of a service, a reduction or termination of a previously authorized service, a denial of payment, or a failure to act within required timeframes. That notice must tell you how to appeal, how to request an expedited appeal, and how to ask that your benefits continue during the appeal.

The internal appeal and exhaustion

You have 60 calendar days from the date on the determination notice to file the plan's internal appeal, and the appeal may be requested orally or in writing. A plan has only one level of appeal, and you must exhaust it before requesting a State Fair Hearing., Contact the plan's Grievance and Appeals Department, or call the plan's customer service line, to file; detailed instructions are in your member handbook.

How fast the plan must decide

Federal rules cap the plan's deadline at 30 calendar days for a standard appeal and 72 hours for an expedited one, and within those caps the plan must decide as quickly as your health condition requires. Either timeframe may be extended by up to 14 calendar days if you request the extension or the plan shows the state that more information is needed and the delay is in your interest. In Arizona, an expedited appeal, resolved within three working days absent an extension, is available when waiting the standard time for a decision would put your health in serious jeopardy.

After the plan upholds its denial

Once the plan issues an unfavorable appeal decision, you may request a State Fair Hearing, which is a hearing where your appeal is presented before an administrative law judge (ALJ). If the plan fails to meet 42 CFR 438.408's notice and timing requirements for resolving your appeal, your appeal is deemed exhausted and you may go straight to a State Fair Hearing. That turns on how the plan handles your appeal, so file the plan's internal appeal within 60 calendar days of the date on the determination notice either way. If you want your benefits to keep running into the hearing, don't wait out the 90-to-120-day window: continued benefits end if you do not request the State Fair Hearing and continuation within 10 calendar days after the plan sends its notice upholding the decision.

How to request an Arizona Medicaid fair hearing

Where your request goes depends on who acted and why, so match your case to the right office before you file.

A State Fair Hearing request, and a fee-for-service appeal to AHCCCS, must be in writing. Match your situation to one of these four paths:

1
Step 1

Health plan (managed care) service denial

Exhaust the plan's internal appeal first (see the section above). If the plan's decision is unfavorable, file a written request for a State Fair Hearing with the AHCCCS Office of the General Counsel.

2
Step 2

Fee-for-service or American Indian Health Plan (AIHP) denial

Members who are not in a managed care plan appeal in writing directly to the AHCCCS Office of the General Counsel, and may request a State Fair Hearing if the AHCCCS decision is unfavorable.

3
Step 3

Eligibility denial

An eligibility appeal goes to the agency that made the determination, which is AHCCCS or, for some cases, the Arizona Department of Economic Security (DES).

4
Step 4

Nursing home transfer or discharge

A resident appealing a nursing home's transfer or discharge uses the AHCCCS Appeal of Transfer/Discharge Form and contacts the Office of the General Counsel at 602-417-4232 or NFdischarges@azahcccs.gov, not the health plan's grievance-and-appeals department. While that appeal is pending, the facility may not transfer or discharge you unless failing to do so would endanger your health or safety or that of others in the facility, a danger it must document.

A written request for a State Fair Hearing on a service denial is filed with the AHCCCS Office of the General Counsel at Arizona Health Care Cost Containment System Administration, 150 N. 18th Ave., MD-15013, Phoenix, AZ 85007. The fax number is 602-253-9115, and you can reach the office by phone at 602-417-4232 within Maricopa County or 1-800-654-8713 ext. 74232 statewide. At the State Fair Hearing, your appeal is presented before an administrative law judge.

Frequently Asked Questions

Do I appeal to my Arizona health plan or to the state first?

If your care is managed by a health plan, you appeal to the plan first. An enrolled member must exhaust the plan's one internal appeal, filed within 60 calendar days of the plan's adverse benefit determination notice, before requesting a State Fair Hearing. Fee-for-service members and those in the American Indian Health Plan (AIHP) instead file their appeal in writing directly with the AHCCCS Office of the General Counsel.

Will I have to pay back benefits if I keep them and lose my appeal?

You might. If you ask to continue your benefits during the appeal and the action is later upheld at the hearing, you may have to pay for the services you received while the appeal was pending. Federal law lets the agency recoup the cost of services that were furnished solely because your benefits were continued.

Do I need a lawyer for an Arizona Medicaid fair hearing?

No. Federal rules say you may represent yourself or use legal counsel, a relative, a friend, or another spokesperson, and the agency must tell you so in writing. In Arizona, your appeal is presented before an administrative law judge. If you are in a health plan, a provider or an authorized representative can also request the appeal or the hearing for you, with your written consent where state law permits.

Can I get a faster decision if waiting would harm my health?

Yes. In Arizona, you can ask your health plan for an expedited appeal, which must be resolved within three working days absent an extension, when waiting the standard timeframe for a decision would put your health in serious jeopardy. The plan's written notice of an adverse benefit determination must explain when an appeal can be expedited and how to request one.

Learn More

MedicaidHow to Appeal a Medicaid DenialDenied Medicaid? You can appeal, and one deadline decides whether your benefits keep flowing during the appeal. Know your fair-hearing rights and act fast. MedicaidArizona Medicaid: A Guide for Seniors and FamiliesArizona Medicaid (AHCCCS/ALTCS) covers long-term care: 2026 income limits, Income-Only Trusts, asset rules, Medicare Savings Programs, and how to apply. MedicaidYour Guide to Arizona Medicaid (AHCCCS and ALTCS) Income and Asset LimitsThe 2026 Arizona Medicaid income limits, both tests: AHCCCS MAGI limits by group (138% FPL for adults, no asset test) and the $2,982 ALTCS long-term-care cap. MedicaidArizona Medicaid HCBS Waivers: How Home Care Works Through ALTCSArizona Medicaid HCBS waivers explained: how ALTCS pays for home and community care, who qualifies, the 2026 income and asset limits, and how to apply. MedicaidHow Arizona Medicaid Estate Recovery WorksHow Arizona Medicaid estate recovery works in 2026: who is affected, what property is at risk, who is protected, and how to respond to an ALTCS claim.

Find personalized help navigating an Arizona 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.

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