Mississippi Medicaid Appeals and Fair Hearings

If your Mississippi 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 In Mississippi that right runs on a tight clock: you have 30 days from the postmark date of your notice to request a hearing, and only 10 days to lock in continued benefits.2 The appeal runs through the Mississippi Division of Medicaid, which offers two levels of hearing, local and state.2

In This Guide

• What you can appeal in Mississippi Medicaid
• The deadlines that decide your Mississippi Medicaid appeal
• How to keep your benefits during the appeal
• Managed care appeals through MississippiCAN
• How to request a fair hearing in Mississippi
• Frequently Asked Questions

What you can appeal in Mississippi 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 Mississippi's Medicaid plan to offer a hearing to anyone whose claim for medical assistance is denied or is not acted on with reasonable promptness. The implementing regulation at 42 CFR 431.220 requires a hearing for anyone who believes the agency acted erroneously, denied a claim for eligibility or covered services, or did not act on the claim promptly, and it adds nursing facility residents facing a transfer or discharge and managed care enrollees.1 The right has one stated limit: the agency need not grant a hearing when the only issue is a federal or state law that automatically changes benefits for some or all beneficiaries.1

In practice, that means you can appeal most decisions the Division of Medicaid makes on your case, including:1

• An application denial or another decision about your eligibility, including the amount of medical expenses you must incur to qualify
• A termination or reduction of your eligibility or covered services
• A denial of a level-of-care determination, including one for a child in Mississippi's Katie Beckett eligibility category
• A prior authorization denial or a reduction in authorized service hours
• A MississippiCAN plan's denial, reduction, or termination of a covered service
• A nursing facility's decision that you must be transferred or discharged

Mississippi treats two categories with extra care. If your case involves a disability or blindness denial or termination, or a level-of-care denial or termination for someone in the Katie Beckett category, a local hearing is not allowed and your case goes straight to a state hearing.2

The deadlines that decide your Mississippi Medicaid appeal

In Mississippi, two windows control the start of an eligibility appeal, and they are not the same number: a 30-day deadline to request a hearing, and a shorter 10-day deadline to keep your benefits while the case is decided.2

The request window is 30 days. Federal law caps a state's fair-hearing deadline at 90 days from the date the notice of action is mailed, but that is a ceiling, and a state may set a shorter operational window.3 Mississippi sets it at 30 days: you have 30 days from the postmark date of your notice to request a local or state hearing.2

The continued-benefits window is shorter still, at 10 days, and it is covered in the next section. Missing the 30-day deadline is not always the end: the Division of Medicaid may extend it if you show good cause for filing late and the facts of your case are unchanged. Without good cause, a late request is refused.2

Each of these deadlines runs from a date fixed by the paperwork (such as the notice's postmark or notice date, or the postmark on a local hearing decision), not from the day the envelope reached your mailbox. For the 10-day and 15-day clocks, Mississippi counts the day the office receives your request, not the day you send it.2 If your coverage ended only because you did not return a renewal form on time, you may not need to appeal at all: under 42 CFR 435.916, the agency must reconsider your eligibility without a new application if you submit that form within 90 days after the termination date, or a longer period if the state chooses one. That duty covers eligibility based on modified adjusted gross income (MAGI). If you qualify through Supplemental Security Income (SSI), age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Mississippi may offer the same window but is not required to, so ask the Division of Medicaid.4

How to keep your benefits during the appeal

If you already have Mississippi Medicaid, your benefits can continue at their current level while your appeal is decided, but only if you ask in time.2 Because the deadline to keep benefits is shorter than the deadline to appeal, it is the easier one to miss.

In Mississippi, the deadline to keep your benefits is 10 days. Benefits continue, or are reinstated, at the level they were before the action only if your hearing request is received by the Medicaid Regional Office within 10 days from the notice date of the adverse action; a later request does not count for continued benefits.2 That is 20 days sooner than the 30-day deadline to appeal, so the 10-day date is the one to watch if you want benefits to continue.

The state rule rests on a federal one. Under 42 CFR 431.230, when the agency sends the required advance notice and you request a hearing before the action takes effect, it may not reduce or terminate your services until a decision is rendered after the hearing.5 Continued coverage carries one cost of losing: if the Division of Medicaid's action is upheld at the hearing, the agency may start recovery procedures against you. That exposure is bounded, though. The same federal rule limits recoupment to the cost of the services furnished solely because your benefits kept running during the appeal, not to every service you received while it was pending.2

Managed care appeals through MississippiCAN

Mississippi's Medicaid managed care program is MississippiCAN (MSCAN), the Mississippi Coordinated Access Network, and its health plans are called coordinated care organizations (CCOs).2 When a CCO denies care, you appeal to the plan before you can reach a state fair hearing.

Exhaust the plan's appeal first. A MississippiCAN beneficiary or provider must exhaust all appeals with the coordinated care organization before requesting a fair or administrative hearing with the Division of Medicaid.2 Federal law adds one exception: if the plan fails to follow the federal notice and timing requirements for resolving your appeal, you are treated as having exhausted its appeal process and can request a state fair hearing directly.2

The federal managed-care rules set the timing. A managed care plan must give you timely written notice of an adverse benefit determination, including a termination, suspension, or reduction of a service it previously approved.6 From the date on that notice, you have 60 calendar days to file the plan's appeal, which you can request orally or in writing.7 If you have Medicare and Medicaid through a single integrated plan, different federal appeal rules apply, so follow the deadline on that plan's notice.7 Federal rules cap the plan's time to resolve a standard appeal at 30 calendar days and an expedited appeal at 72 hours, and the plan must act as fast as your health requires. Either deadline can be extended by up to 14 calendar days, and if the plan extends it without your asking, it must tell you in writing within 2 calendar days and explain your right to file a grievance.8 The plan's denial notice must explain when an appeal can be expedited and how to ask, so request the faster track if your health can't wait.6

After the plan upholds its denial, you can move to a state fair hearing. The state must give you between 90 and 120 calendar days from the date of the plan's notice of resolution to request that hearing, with the exact number set by the state.8 Your coverage runs on a much shorter clock. Benefits continue while the hearing is pending only if you request the hearing and continued benefits within 10 calendar days after the plan sends its appeal decision, so waiting out the full window keeps your appeal alive but can cost you the service in the meantime.8

How to request a fair hearing in Mississippi

Mississippi's fair hearing process has two levels, both run by the Division of Medicaid, and you can ask for a local hearing, a state hearing, or both. A local hearing is an informal proceeding at the Medicaid Regional Office. It includes a supervisory review of the action, the staff member who runs it cannot be someone who made or directed the decision, and you can bring new information, question the action, and have the eligibility rules explained. A state hearing goes to an impartial hearing officer who was not involved in the action, and it is recorded; the Executive Director of the Division of Medicaid then issues the final decision.2 If you lose a local hearing, the state hearing request has its own, shorter clock: within 15 days of the postmark date on the local hearing decision, which means the office must receive it by the fifteenth day after that decision is mailed, unless your original 30-day window is still open. If your benefits continued through the local hearing, they keep running pending the state hearing only if you ask for it inside that 15-day period.2 The Division of Medicaid must take final action within 90 days of the date of your first hearing request.2

To start, you can ask for a hearing in writing, orally, or in person at a Medicaid Regional Office, and you can mail a written request to the Regional Office or to the Division of Medicaid's central office. When the action reduces, denies, suspends, or ends a covered service, Mississippi's rule says to request the hearing in writing within 30 days of the notice, so a written request is the safe choice in that case.2

Local and state hearings are held by telephone unless the hearing officer decides an in-person hearing is necessary.2 The Executive Director's decision after a state hearing is final and binding, and after it your only further recourse is judicial review in court.2

Learn More

Find personalized help navigating a Mississippi 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.