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 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 the state plan to grant a hearing to anyone whose claim for medical assistance is denied or is not acted on with reasonable promptness. Under 42 CFR 431.220, the agency must also grant a hearing to anyone who believes it acted erroneously, denied a claim for eligibility or covered services, or issued a determination of their liability, and to a nursing facility resident who believes the facility wrongly decided to transfer or discharge them. Managed care enrollees entitled to a hearing under the federal managed care rules are covered too. The right has one stated limit: the agency need not grant a hearing when the sole issue is a federal or state law that requires an automatic change adversely affecting some or all beneficiaries.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 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.

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 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 on time, you do not always have to reapply: under 42 CFR 435.916, if you submit the renewal form within 90 days after the termination date, the agency must reconsider your eligibility without a new application. The 90 days run from the date of termination, and a state may choose a longer period but not a shorter one. That federal duty covers eligibility based on modified adjusted gross income (MAGI). If you qualify through SSI, age, blindness or disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Louisiana may offer the same window but is not required to, so ask LDH.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. That protection has one narrow exception, and both halves of it must be met: the hearing determines that the sole issue is one of federal or state law or policy, and the agency promptly tells you in writing that services are to be terminated or reduced pending the decision.4 The trigger is the date of action on your notice, so the earlier you file, the safer your coverage.

Missed the date of action? Two federal rules still apply. 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 cut your services without the advance notice the rules require, reinstatement is mandatory: it must restore and continue them until the hearing decision if you request a hearing within 10 days of receiving the notice (counted as 5 days after the date on it unless you show it arrived later) and the action did not result from applying federal or state law or policy.4

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 solely because of the continuation, so weigh that where the notice warns of it.4

Managed care appeals through Healthy Louisiana

Most Louisiana Medicaid enrollees get their care through Healthy Louisiana, the state's Medicaid managed care program. For 2026, LDH extended its managed-care contracts for an additional year and is moving forward with 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 generally appeal to the plan before you can reach a state fair hearing. LDH is direct about the order: appeal with your health plan first (you can ask the plan's member services for an appeal), 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 notice in writing of an adverse benefit determination, including when it ends, suspends, or reduces a service it already approved. That notice must explain the reasons for the decision and your right to free copies of the records and medical-necessity criteria behind it, how to appeal to the plan and then request a state fair hearing, when and how you can get an expedited appeal, and how to ask that your benefits continue, along with when you might have to pay for those continued services.8

The plan appeal comes first. You have 60 calendar days from the date on the determination notice to file it, and you can request it orally or in writing. Each MCO may have only one level of appeal. With your written consent, and if state law permits, a provider or an authorized representative can file the appeal or request the state fair hearing for you. You can file a grievance with the plan at any time; the 60 days apply to appeals only.5 If you have both Medicare and Medicaid and are enrolled in an applicable integrated plan, plan-level appeals follow 42 CFR 422.629 through 422.634 instead of this 60-day rule, so check the plan's notice.5

To keep a previously authorized service going while the plan decides, file for continuation on or before the later of 10 calendar days after the plan sends its notice or the date the change is set to take effect. Continuation also requires that you filed the appeal on time, that an authorized provider ordered the service, and that the original authorization period has not run out.6

Federal rules cap how long the plan can take. The state's deadline for a standard appeal can be no longer than 30 calendar days from when the plan receives it, and no longer than 72 hours for an expedited appeal, and the plan must decide as quickly as your health condition requires within those limits. Either deadline can stretch by up to 14 calendar days if you ask for more time, or if the plan satisfies the state that it needs additional information and that the delay is in your interest. If the plan takes that extra time without your asking, it must tell you in writing within 2 calendar days why, and you can file a grievance if you disagree.6 Ask for the expedited track if waiting could harm your health; the plan's notice must explain when an appeal can be expedited and how to request it.8

A state fair hearing generally comes only after the plan notifies you that it is upholding its decision. The exception: if the plan does not follow the federal notice and timing requirements for resolving your appeal, you are treated as having exhausted the plan's appeal process and can request the state fair hearing without waiting.6

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 Watch the second, much shorter clock: if you want your services to continue while the hearing is pending, you must request the state fair hearing and continuation within 10 calendar days after the plan sends its appeal decision. If the hearing upholds the plan's decision, the plan may recover the cost of services you received only because of that continuation.6

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 DAL lists three ways to file a written request:

• 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

LDH's own appeals page also lists a phone route, at 225-342-5800 or 225-342-0443, but says phone appeals are allowed and not recommended, and it asks you to choose only one way to file.2 A written request leaves you a record of what you asked for and when.

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 that the plan appeal generally comes before you file here.6

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.