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, you can often keep your benefits 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 guarantees every Medicaid applicant and enrollee 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.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

The right runs across the program, whether the decision came from the state or from your health plan. What changes from case to case is the deadline and the office you file with.

Maryland Medicaid appeal deadlines that decide your case

Deadlines, not arguments, are what most often cost a family its coverage. In Maryland, three time limits matter, and they are not the same number.

The request window is 90 days. Federal rules require the state to allow up to 90 days from the date the notice of action is mailed to request a hearing, and Maryland applies that 90-day limit to most Medicaid decisions.1,4 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 This is the shortest and most consequential deadline, and the next section explains how it works.

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.1,5

One more protection applies to renewals. If Maryland ended your coverage only because you did not return a renewal form or requested information on time, federal law requires the agency to reconsider your eligibility without a new application, as long as you submit what was missing within 90 days after the termination date.6

How to keep your benefits during a Maryland Medicaid appeal

This is the most valuable protection in the appeal system, 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

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 only when you file before the effective date of the action; a request made after that date does not keep your benefits flowing.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, and why continuation is never automatic.

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

Most Maryland 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 or limits a service you asked for, or reduces, suspends, or ends a service it already authorized.7,1 That notice must explain how to appeal and how to ask that your benefits continue during the appeal.

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.1,5

The plan must resolve a standard appeal within 30 calendar days and an expedited appeal within 72 hours, and either deadline can be extended by up to 14 calendar days.8 You can ask for the expedited track when waiting on the standard timeline could seriously jeopardize your life, health, or ability to attain, maintain, or regain maximum function.9

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.10

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). The fastest way is MDH's online Medicaid Request for Fair Hearing form, and you can also mail or fax your request.1 You will get an email confirmation and a copy of your completed form, and later a hearing notice from the Office of Administrative Hearings.

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 Office of Administrative Hearings (OAH) is the independent state agency where an Administrative Law Judge (ALJ) hears the evidence and issues the decision. It holds hearings 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.