If MaineCare denies, reduces, or ends a covered service, you have a right to a Fair Hearing, and requesting it within 10 days of the date on the letter keeps your services running until a decision. A Maine Medicaid appeal (MaineCare is Maine's Medicaid program) is heard by the Maine Department of Health and Human Services (DHHS) Division of Administrative Hearings, and you must request your Fair Hearing within 60 days of the date on the letter.

In This Guide

What a Maine Medicaid Appeal Can Challenge

Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency. Section 1902(a)(3) of the Social Security Act and its implementing regulation, 42 CFR 431.220, require the state to grant a hearing to anyone whose claim for medical assistance is denied, is not acted on with reasonable promptness, or who believes the agency made an erroneous or adverse determination. In Maine, that hearing is the MaineCare Fair Hearing.

In most situations, if you disagree with a MaineCare decision to deny, terminate, or reduce your covered services, you have a right to a Fair Hearing. That covers the situations families most often reach us about:

  • An application or eligibility denial
  • A termination or reduction of a covered service you already receive
  • A denial of a specific service, item, or level of care
  • A renewal or recertification that ends your coverage

The Division of Administrative Hearings hears more than MaineCare cases. Its docket includes medical-eligibility determinations, MaineCare, Food Supplement, Temporary Assistance for Needy Families, and other DHHS matters, and hearings are held at the department's regional offices from Sanford to Fort Kent. For the broader program, see the Maine Medicaid guide; for the federal appeal framework every state follows, see how to appeal a Medicaid denial.

Maine Medicaid Appeal Deadlines: 60 Days to File, 10 to Keep Services

The request window is 60 days. You can ask for a Fair Hearing up to 60 days from the date on the letter that denied, reduced, or terminated your service. That is shorter than the federal ceiling. Under 42 CFR 431.221(d), a state must allow a reasonable time not to exceed 90 days from the date the notice is mailed, but a state may set a shorter operational window, and Maine sets its MaineCare window at 60 days., Do not read the federal 90-day figure and assume you have that long in Maine; the operative deadline here is 60 days.

The continuation window is 10 days. This is the earlier deadline, and it is the one that keeps your services flowing during the appeal. If you request the hearing within 10 days of the date on the letter, your current services continue until a decision is made.

One more federal deadline protects renewals. If your MaineCare ended only because you did not return a renewal form on time, you do not always have to appeal or 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. That duty covers eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Maine may offer the same window but is not required to, so ask MaineCare Member Services.

How to Keep Your MaineCare During the Appeal

Whether your services continue during the appeal turns on timing, not on the strength of your case. Meet the 10-day mark and your current services keep going until a decision is made; miss it and you can still appeal within the 60-day window, but your service may stop while the appeal is pending.

The rule comes from federal law. Under 42 CFR 431.230(a), when the agency sends the required 10-day advance notice and you request a hearing before the date the action takes effect, it may not terminate or reduce your services until a decision is rendered after the hearing, unless the only issue is one of law or policy. Two practical points follow:

  • It is not automatic. You have to request the hearing inside the 10-day window. Read the date off your letter and file before the 10 days run out.
  • You may owe the money back if you lose. Under 42 CFR 431.230(b), when services continue during the appeal and the department's action is later upheld, the agency may recover the cost of the services furnished solely because your services kept flowing.

How to Request a Maine Medicaid Fair Hearing

You request the hearing from MaineCare within the 60-day window, by phone or in writing. To keep your services, get the request in within 10 days of the date on the letter.

1
Step 1

Find the date on your letter

Every deadline runs from the date printed on the notice. Mark both the 10-day continuation mark and the 60-day filing deadline.

2
Step 2

Call MaineCare Member Services

Reach MaineCare Member Services at 1-800-977-6740 (TTY users dial 711, Maine relay) and ask for a Fair Hearing.

3
Step 3

Or write to the Hearings Coordinator

Send your request to the MaineCare Hearings Coordinator, Division of HealthCare Management, MaineCare Services, 11 State House Station, Augusta, ME 04333-0011. Keep a copy and note the date you sent it.

4
Step 4

Ask for your services to continue

If you are inside the 10-day window and want your current services to keep going, say so in the request.

5
Step 5

Gather your evidence

For a service or level-of-care dispute, a letter from your treating provider documenting the need is strong evidence to bring.

The hearing itself is held by the DHHS Division of Administrative Hearings, which hears cases for people aggrieved by the department's actions or inactions on MaineCare and medical-eligibility matters, at DHHS regional offices around the state.

Frequently Asked Questions

How long do I have to appeal a MaineCare denial?

You can ask for a Fair Hearing up to 60 days from the date on the letter. Federal law caps the request window at 90 days from the date the notice is mailed, but a state may set a shorter one, and Maine's MaineCare window is 60 days, so that is the deadline that governs you., If you want your services to continue while you appeal, request the hearing within 10 days of the date on the letter.

My MaineCare was terminated because I missed my renewal paperwork. Do I have to file an appeal?

Not necessarily. Under 42 CFR 435.916, if your coverage ended only because you did not return a renewal form on time and you submit that form within 90 days after the termination date, the agency must reconsider your eligibility without a new application (required for MAGI-based coverage; a state option otherwise). You can also still ask for a Fair Hearing within 60 days of the date on the letter if you believe the termination was wrong.

If I keep my services during the appeal and then lose, do I have to pay MaineCare back?

Possibly. Under 42 CFR 431.230(b), when your services continue during the appeal and the department's action is later upheld, the agency may recover the cost of the services furnished solely because your services kept flowing. Weigh that risk against the value of keeping the service before you decide to request continuation inside the 10-day window.

Where is my MaineCare Fair Hearing held?

The DHHS Division of Administrative Hearings holds MaineCare hearings, and they are generally held at the Maine DHHS regional offices around the state, from Sanford to Fort Kent.

Can someone else handle my MaineCare appeal for me?

Yes. Federal rules let you name an authorized representative, an individual or an organization, to act on your behalf in your dealings with the Medicaid agency, including submitting your hearing request and other communications. A court-appointed guardian or a power of attorney counts as that designation.

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. MedicaidMaine Medicaid: A Guide for Seniors and FamiliesMaine Medicaid (MaineCare) 2026: about $10,000 asset limit, spend-down with no Miller Trust, $40 PNA, spousal protections, estate recovery, and how to apply. MedicaidHow to Apply for Maine MedicaidHow to apply for Maine Medicaid (MaineCare) in 2026: online via My Maine Connection, by mail, e-mail, or fax, or in person. Documents, spend-down, and appeals. MedicaidYour Guide to Maine Medicaid Income and Asset LimitsMaine Medicaid income limits for 2026: the $2,982 cap, the MaineCare savings disregard that keeps about $10,000 in assets, the spend-down, and spousal rules. MedicaidHow Maine Medicaid Estate Recovery WorksMaineCare estate recovery 2026: who is subject at age 55, Maine's expanded estate definition, family protections, and the 180% hardship waiver explained.

Find personalized help appealing a MaineCare denial 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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