Maryland Medicaid Appeals and Fair Hearings

If your Maryland Medicaid coverage was denied, cut, or terminated, you have the right to appeal that decision and request a fair hearing.1,2 If you already have Medicaid and file your appeal before the decision takes effect, your benefits may continue while the case is decided.1,3

In This Guide

• What you can appeal in Maryland Medicaid
• Maryland Medicaid appeal deadlines that decide your case
• How to keep your benefits during a Maryland Medicaid appeal
• Managed care appeals through a HealthChoice plan
• How to request a Maryland Medicaid fair hearing

What you can appeal in Maryland Medicaid

Federal law gives Medicaid applicants and enrollees the right to a fair hearing before the state agency when a claim for assistance is denied or is not acted on with reasonable promptness, or when they believe the agency acted wrongly on their eligibility or covered services.2 The right has one stated limit: the agency does not have to grant a hearing when the only issue is a federal or state law that automatically changes benefits for some or all enrollees.2 In Maryland, that right reaches any decision to deny, suspend, end, or reduce your Medicaid eligibility or services.1

In practice, that means you can appeal:

• An application denial (income, assets, or missing documentation)
• A termination or reduction of eligibility or covered services
• A cut to your authorized service hours, such as personal care or in-home support
• A prior authorization denial or a level-of-care decision
• A HealthChoice plan's denial, reduction, suspension, or termination of a service
• A nursing facility's decision that you must be transferred or discharged2

Maryland Medicaid appeal deadlines that decide your case

A missed deadline can cost a family its coverage before anyone looks at the merits. In Maryland, three time limits matter, and they are not the same number.

The request window is 90 days in Maryland. Federal rules set 90 days from the mailing of the notice of action as the ceiling: it is the most a state may give you, not a floor you are entitled to, and a state that sets a shorter deadline can enforce it. Maryland applies the full 90 days to most Medicaid decisions, so 90 is the operative number here.1 Read the exact date off your own notice, and count from the notice date rather than the day it reached your mailbox.

The keep-benefits window is far shorter: 10 calendar days. To keep your current benefits while the appeal is pending, you must file within 10 calendar days of the notice date, the postmark, or the effective date of the action, whichever is later.1,3

The managed care window is 60 days. If your denial came from a HealthChoice managed care organization, you have 60 days from the date on the denial notice to file the plan's internal appeal, which you must complete before a State fair hearing.1,4

One more protection applies to renewals. If Maryland ended your coverage only because you did not return your renewal form or requested information, federal law requires the agency to reconsider your eligibility without a new application, as long as you submit the renewal form within 90 days after the termination date (a state may allow longer, never less). That duty covers eligibility based on modified adjusted gross income (MAGI). If you qualify through SSI, age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Maryland may offer the same window but is not required to, so ask the Maryland Department of Health.5

How to keep your benefits during a Maryland Medicaid appeal

This protection can keep care in place while you wait, and it is not automatic. Under the federal maintaining-services rule, if you already have Medicaid and request a hearing before the effective date of the action, your coverage continues until the fair hearing decision is issued.1,3 The agency can cut services before the decision only if two things are both true: the hearing finds the only issue is one of federal or state law or policy, and the agency promptly tells you in writing that services will be cut while you wait for the decision.1,3

In Maryland, the practical deadline is 10 calendar days from the notice date, the postmark, or the effective date of action, whichever is later.1 Continuation applies when you file before the effective date of the action; a request made after that date does not keep your benefits flowing automatically, but it is not the end of the road. If you are only a few days late, ask anyway: a separate federal rule, 42 CFR 431.231, lets the agency reinstate services when you request a hearing no more than 10 days after the date of action.3 If your services were cut without the advance notice the rules require, reinstatement is not optional: the agency must restore them until the hearing decision if you request a hearing within 10 days of receiving the notice (treated as 5 days after the date on it unless you show it came later), as long as the cut did not simply result from applying federal or state law or policy.3

There is one cost to weigh. If your benefits continue and the agency's decision is later upheld at the hearing, Maryland may recover the cost of the services you received while the appeal was pending.1,3 That risk is why the decision to continue benefits is yours to make. Don't assume continuation will happen on its own; ask for it explicitly.3

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 appeals through a HealthChoice plan

Maryland is a managed care state: many Medicaid members get their care through HealthChoice, the state's managed care program, and their coverage runs through a managed care organization (MCO), sometimes just called a health plan. When an MCO denies, reduces, or ends a service, you appeal to the plan first, before you can reach a State fair hearing.1

Federal managed care rules require the plan to give you written notice whenever it denies a service you asked for, or reduces, suspends, or ends a service it already authorized.6,1 That notice must explain the reasons for the decision, your right to free copies of the records and medical-necessity criteria behind it, how to appeal, when you can ask for an expedited appeal, and how to ask that your benefits continue during the appeal.6

The internal appeal comes first. You have 60 days from the date on the determination notice to file the plan's internal appeal, and you must exhaust that appeal before requesting a State fair hearing, unless the plan misses its own deadlines (see below).1,4

Federal rules cap how long the plan can take: no more than 30 calendar days for a standard appeal and 72 hours for an expedited one, and within those caps the plan must decide as fast as your health requires.7 Either deadline can be extended by up to 14 calendar days, but only if you ask for the extension or the plan shows the state it needs more information and the delay is in your interest. If the plan extends on its own, it must tell you in writing within 2 calendar days and explain your right to file a grievance if you disagree.7 Speed matters earlier, too: when you first ask the plan to approve a service and waiting on the standard timeline could seriously jeopardize your life, health, or ability to attain, maintain, or regain maximum function, the plan must decide no later than 72 hours after your request, unless you ask for more time or the plan shows it needs more information and the delay is in your interest.8

Once the plan upholds its denial, you can request a State fair hearing. Federal rules give you no fewer than 90 and no more than 120 days from the plan's resolution notice, with the exact number set by the state.7 If the plan misses its notice or timing deadlines, you are treated as having finished the plan appeal and can go straight to a State fair hearing.7 Watch the second, shorter clock: continued benefits end if you don't request the State fair hearing and continuation of benefits within 10 calendar days after the plan sends its appeal decision.7

If you have both Medicare and Medicaid and are enrolled in an integrated plan that covers both (an applicable integrated plan), these plan-level deadlines don't apply; the integrated appeal rules in the Medicare Part C regulations govern instead, so follow the timelines on your plan's notice.4,8

As of 2026, HealthChoice members choose from nine plans: Aetna Better Health, CareFirst, Jai Medical Systems, Kaiser Permanente, Maryland Physicians Care, MedStar Family Choice, Priority Partners, UnitedHealthcare, and Wellpoint Maryland.1

How to request a Maryland Medicaid fair hearing

You request a fair hearing through the Maryland Department of Health (MDH). MDH says the best way is its online Medicaid Request for Fair Hearing form, and you can also mail or fax your request.1 Keep a copy of whatever you send, and watch for word from the Office of Administrative Hearings, which holds the hearing.

Mail or fax your request to the Maryland Department of Health, Attention: Medicaid Appeals, 201 West Preston St., L9, Baltimore, MD 21201. Fax: 410-333-5154. Email: mdh.medicaidappeals@maryland.gov.1

The Maryland Office of Administrative Hearings (OAH) conducts the hearing itself. It is located at 11101 Gilroy Rd., Hunt Valley, MD 21031, and can be reached at 410-229-4100.1 If you get care through a HealthChoice plan, finish the plan's internal appeal before you file here.

Learn More

Find personalized help navigating a Maryland 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.