Louisiana Medicaid Appeals and Fair Hearings

If your Louisiana Medicaid was denied, cut, or terminated, you have the right to appeal and request a fair hearing, and you can often keep your benefits while the appeal is decided.1,2 The deadline that governs you is printed on your notice: Louisiana directs you to request a hearing typically within 30 days of the date on the decision, while federal law caps that window at 90 days.2,3

In This Guide

• Key deadlines at a glance
• What you can appeal in Louisiana Medicaid
• The Louisiana Medicaid appeal deadlines that decide your case
• How to keep your benefits during a Louisiana Medicaid appeal
• Managed care appeals through Healthy Louisiana
• How to request a Louisiana Medicaid fair hearing
• Frequently Asked Questions

What you can appeal in Louisiana Medicaid

Federal law guarantees every Medicaid applicant and beneficiary a fair hearing before the state agency. Section 1902(a)(3) of the Social Security Act (42 USC 1396a(a)(3)) requires the state plan to grant a hearing to anyone whose claim for medical assistance is denied or is not acted on with reasonable promptness, and 42 CFR 431.220 extends that right to anyone who believes the agency acted erroneously or made an adverse determination.1 In Louisiana, that hearing is heard by an impartial hearing officer at the Louisiana Division of Administrative Law (DAL), a separate adjudicatory body from the Louisiana Department of Health (LDH) that issued the decision.2

In practice, you can appeal:

• A denial of your application (income, assets, household composition, or documentation)
• A termination or reduction of eligibility or covered services
• A reduction in service hours, such as personal care or home health
• A prior authorization denial or a level-of-care determination
• A managed care plan's denial, reduction, suspension, or termination of a service

The right reaches across the program, whether your Medicaid comes directly from the state or through a Healthy Louisiana health plan.

The Louisiana Medicaid appeal deadlines that decide your case

The appeal windows below are not all the same length, so match your notice to the one that applies to your situation.

The request window is where Louisiana and federal law diverge. The Louisiana Division of Administrative Law directs applicants and recipients to request a fair hearing timely, typically within 30 days of the date of the decision notice issued by LDH.2 Federal law sets the outer limit: 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 hearing.3 Do not assume 90 days. The notice tells you when to file, and you must file by that date.

A separate window governs whether your services keep flowing while the appeal is pending. That continuation window turns on appealing early, and it is covered in the next section.

Managed care adds its own two windows. If your denial came from a Healthy Louisiana plan, you have 60 calendar days from the date on the adverse benefit determination notice to file the plan's internal appeal.5 After the plan upholds its denial, the state must give you no less 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.6

One more deadline protects renewals. If your coverage ended 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 you submit the form or the missing information within 90 days after the termination date, the agency must reconsider your eligibility without a new application.7

How to keep your benefits during a Louisiana Medicaid appeal

Keeping your benefits during an appeal, often called aid paid pending, is not automatic, and the timing is what decides it.

Under the Louisiana rule, LDH tells enrollees that if you appeal within 10 days of the denial, your current services will not be stopped while your appeal is reviewed.2 Acting inside that 10-day window is the surest way to hold your coverage in place.

The federal rule behind it is 42 CFR 431.230(a): if the agency sent the required advance notice and you request the hearing before the date of action stated on that notice, the agency may not terminate or reduce your services until a decision is rendered after the hearing, unless the only issue is one of federal or state law or policy.4 The trigger is the date of action on your notice, so the earlier you file, the safer your coverage.

For timing, LDH states that you should get a final decision within 30 days of filing your appeal, unless more time is agreed on.2

The practical takeaway: when an adverse-action notice arrives, find the date of action, request the hearing before it, and ask in writing that your benefits continue. If you win, your coverage never lapsed. If you lose after benefits continued, the agency may be able to recover the cost of the services provided during the appeal, so weigh that where the notice warns of it.

Managed care appeals through Healthy Louisiana

Most Louisiana Medicaid enrollees get their care through Healthy Louisiana, the state's Medicaid managed care program. For state fiscal year 2026, Healthy Louisiana operates through five managed care organizations (MCOs): Aetna Better Health, AmeriHealth Caritas Louisiana, Healthy Blue, Humana, and Louisiana Healthcare Connections.2 When a plan denies care, you appeal to the plan before you can reach a state fair hearing. LDH is direct about the order: appeal with your health plan first, and if you believe the plan's decision is wrong, you can then request a state fair hearing.2 These rules come from the federal managed care regulations at 42 CFR Part 438.

Under 42 CFR 438.404, your plan must give you timely, written notice of an adverse benefit determination, including when it ends, suspends, or reduces a service it already approved. 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.8

The internal appeal comes first. You have 60 calendar days from the date on the determination notice to file the plan's internal appeal, and you can request it orally or in writing.5 The plan has only one level of appeal, and you must complete it before requesting a state fair hearing.

The plan must resolve a standard appeal within 30 calendar days and an expedited appeal within 72 hours of receiving it. Either timeframe can 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.9 Ask for the expedited 72-hour track whenever waiting on the standard timeline could seriously jeopardize your life, health, or ability to regain function.

Once the plan upholds its denial, you have 90 to 120 days, the exact number set by the state, to request a state fair hearing through the Louisiana Division of Administrative Law.6 The plan's decision notice includes information on how to request that hearing.2

How to request a Louisiana Medicaid fair hearing

A Louisiana Medicaid fair hearing is requested through the Louisiana Division of Administrative Law, Health and Hospitals (HH) Section, where an impartial hearing officer, separate from the agency that made the decision, hears the case.2 There are three ways to file:

• Online. Submit the Recipient/Applicant Appeal Request Form on the Division of Administrative Law website.2
• By mail. Send a written request to the Division of Administrative Law, ATTN: HH Section, P.O. Box 4189, Baton Rouge, LA 70821.2
• By fax. Fax your request to (225) 219-9823.2

Whichever method you use, review the notice from LDH first: it carries your filing deadline and instructions on requesting the hearing and on keeping your benefits pending the hearing.2 If your denial came from a Healthy Louisiana plan, remember to finish the plan's internal appeal before you file here.

Learn More

Find personalized help navigating a Louisiana 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.