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 In Mississippi that right runs on a tight clock: you have 30 days from the date your notice was mailed to request a hearing, and only 15 days to lock in continued coverage.2 The appeal runs through the Mississippi Division of Medicaid, which decides your case in a two-step hearing process.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 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 (42 USC 1396a(a)(3)) requires Mississippi's Medicaid plan to give a hearing to anyone whose claim for medical assistance is denied or is not acted on with reasonable promptness, and the implementing regulation at 42 CFR 431.220 extends that right to anyone who believes the agency made an adverse determination.1

In practice, that means you can appeal any action the Division of Medicaid takes on your case, including:

• An application denial (income, assets, disability status, or citizenship and identity documentation)
• A termination or reduction of your eligibility or covered services
• A denial of a level-of-care determination, including a level-of-care denial for a disabled child living at home
• A prior authorization denial or a reduction in authorized service hours
• A MississippiCAN plan's denial, reduction, or termination of a covered service

Mississippi treats two categories with extra care. If your case involves a disability or blindness denial or termination, or a level-of-care denial for a disabled child living at home, the Division of Medicaid must hold a formal state hearing, not just an informal local review.2

The deadlines that decide your Mississippi Medicaid appeal

In Mississippi, two windows control an eligibility appeal, and they are not the same number: a 30-day deadline to request a hearing, and a shorter 15-day deadline to keep your coverage 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 must request a local or state hearing before 30 days from the date of mailing printed on your notice.2

The continued-coverage window is shorter still, at 15 days, and it is covered in the next section. For a denial from a MississippiCAN plan, a separate set of federal managed-care deadlines applies, laid out under Managed care appeals through MississippiCAN below.

Every one of these deadlines runs from a date printed on your notice, not from the day the envelope reached your mailbox.2 If your coverage ended only because you did not return a renewal form or requested information 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 what was missing within 90 days of the termination date.4

How to keep your benefits during the appeal

If you already have Medicaid or the Children's Health Insurance Program (CHIP), that coverage can continue while your appeal is decided, but only if you ask in time. Because the deadline to keep coverage is shorter than the deadline to appeal, this is the protection beneficiaries most often miss.

In Mississippi, the deadline to keep your coverage is 15 days. A person already enrolled keeps their Medicaid or CHIP coverage during the appeal only if the hearing is requested within 15 days of the date of mailing on the notice.2 That is 15 days earlier than the 30-day deadline to appeal, so the earlier 15-day date is the one to watch if you want coverage 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 recover the cost of the benefits it furnished while your appeal was pending.2

The practical takeaway: when an adverse-action notice arrives, find the mailing date on it and request your hearing within 15 days if you want your coverage to keep flowing. Continued coverage is not automatic, so ask for it in the same request.

Managed care appeals through MississippiCAN

Most Mississippi Medicaid beneficiaries who use managed care are enrolled in MississippiCAN (MSCAN), the state's statewide coordinated care program. The Division of Medicaid delivers MississippiCAN through three coordinated care organizations (CCOs): Magnolia Health, Molina Healthcare, and TrueCare.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 Skipping the plan appeal and going straight to the Division of Medicaid will get the hearing request dismissed.

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 internal appeal, which you can request orally or in writing.7 The plan must resolve a standard appeal within 30 calendar days and an expedited appeal within 72 hours; ask for the expedited track whenever waiting on the standard timeline could seriously jeopardize your health or ability to regain function.8

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.9

How to request a fair hearing in Mississippi

Mississippi runs a two-step process inside the Division of Medicaid, and there is no separate outside hearings office to file with. First comes a local hearing, an informal review by a Medicaid Regional Office supervisor who did not handle the original action. If you disagree with that outcome, you can request a state hearing, a formal review conducted by a Division of Medicaid State Hearing Officer who has not been involved in your case; the Director of the Division of Medicaid then issues the final agency decision.2

To start, contact the Medicaid Regional Office shown on your notice. You can request a hearing in person, by mail, by telephone, or by other accepted electronic means such as fax or e-mail, or online through the general inquiry form under the Contact link at medicaid.ms.gov. You can also call the Division of Medicaid Office of Eligibility toll-free at 800-421-2408 for help.2

Local and state hearings are held by telephone unless the hearing officer decides an in-person hearing is necessary.2 The state hearing decision is final within the Division of Medicaid, so you cannot request another hearing on the same issue. Your only further recourse is judicial review in a court of appropriate jurisdiction.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.