If your Montana Medicaid is denied, reduced, or terminated, Montana gives you up to 90 days to appeal and request a fair hearing, and some decisions give you only 30., Filing before the change takes effect keeps your benefits at the same level while the appeal is pending., A Montana Medicaid appeal (Montana's Medicaid program is administered by the Department of Public Health and Human Services, or DPHHS) is handled by the DPHHS Office of Administrative Hearings (OAH), formerly the Office of Fair Hearings, which conducts impartial administrative hearings on decisions the Department makes. Put your request in writing and get it to DPHHS by the deadline printed on your adverse-action notice, which for most decisions is 90 days from the date it was mailed; if you file before the action takes effect, your benefits continue during the appeal.

In This Guide

What You Can Appeal in Montana 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)) and the implementing regulation at 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 took an erroneous or adverse action. In Montana, DPHHS carries out that right, and every applicant or recipient who disagrees with a decision that denies, delays, reduces, or terminates coverage or benefits is entitled to due process and a fair hearing. Montana's process is one state's version of the shared federal framework our national Medicaid appeals guide explains.

You can request a fair hearing to challenge:

  • An application that is denied or not processed on time
  • A reduction or termination of your eligibility or a covered benefit
  • A renewal or recertification denial
  • A determination of how much you must pay toward the cost of institutional (nursing-home) care

Because federal rules let you keep your Medicaid while an appeal is pending when you request the hearing in time, an existing recipient facing a cut or termination does not lose coverage just for appealing.

Montana Medicaid Appeal Deadlines That Decide Your Case

Montana runs on the federal deadline for most decisions, with one shorter window that matters directly to long-term-care families.

The standard request window is 90 days. Your written hearing request must reach DPHHS within 90 days of the date the adverse-action notice is mailed. Montana's 90-day window tracks the federal ceiling at 42 CFR 431.221(d), which allows a reasonable time not to exceed 90 days from the date the notice of action is mailed. That 90 days is the maximum a state may allow, not a floor you are entitled to, and a state that sets a shorter window can enforce it. Montana sets a shorter one for nursing-home cost-of-care decisions, so read the deadline off your own notice rather than assuming you have 90 days.

The nursing-home window is shorter, at 30 days. A hearing request disputing DPHHS's determination of your ability to pay for the cost of institutional (nursing-home) care must reach Montana's DPHHS in writing within 30 days of the notice mailing.

Two later deadlines govern what happens after the hearing decision. If you disagree with the decision, an appeal to the Board of Public Assistance must be received within 15 days of the date the decision notice is mailed, extendable to no more than 45 days for good cause. After the Board issues its final decision, a further appeal to district court must be filed within 30 days.

One federal protection can save you an appeal entirely. If your Medicaid was terminated 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, Montana may offer the same window but is not required to, so ask DPHHS.

How to Keep Your Benefits During a Montana Medicaid Appeal

Continued benefits, sometimes called aid paid pending, turn on timing. In Montana, unless you state that you do not want them, your benefits are automatically continued or reinstated at the same level until the hearing decision when your hearing request is filed between the date the adverse-action notice is mailed and the date the action takes effect.

The rule comes from federal law. Under 42 CFR 431.230(a), if the agency sent the required advance notice and you request the hearing before the date the action takes effect, it may not reduce or terminate your services until a decision is rendered after the hearing, unless the only issue is one of law or policy. The trigger is the effective date on your notice, not a flat count from the day you opened the envelope.

Two Montana-specific points follow:

Can You Request an Administrative Review Before a Fair Hearing?

Yes. Before you request a formal hearing, you may first ask for an Administrative Review, which is a meeting between you (or your representative) and DPHHS Fair Hearing Unit staff. An Administrative Review does not diminish, delay, or void your right to a fair hearing, so asking for one does not cost you the deadline, and it can resolve a dispute without waiting for a formal decision. For the bigger picture of who qualifies and how coverage works, see our Montana Medicaid guide or browse all of Brevy's Medicaid coverage.

How to Request a Montana Medicaid Fair Hearing

Your hearing request must be in writing, and DPHHS must receive it within the deadline that applies to your notice. Your signature is not required for the request to count. Fair-hearing rights, information about continuing benefits, and repayment requirements are printed on the back of every adverse-action notice, and the Office of Administrative Hearings directs claimants to follow the instructions on that notice.

You can reach the DPHHS Office of Administrative Hearings in any of these ways:

  • By phone at (406) 444-2470
  • By email at hhsofh@mt.gov
  • By mail to the DPHHS Office of Administrative Hearings, PO Box 202922, Helena MT 59620

The OAH conducts impartial administrative hearings on the Department's decisions, and its decision can be appealed to the Board of Public Assistance and then to district court.

Frequently Asked Questions

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

Not necessarily. Under 42 CFR 435.916, if your Medicaid 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 request a fair hearing within 90 days of the date your adverse-action notice is mailed if you believe the termination was wrong.

I was told how much I owe toward my nursing-home care. How long do I have to appeal?

Less time than a standard appeal. A hearing request disputing DPHHS's determination of your ability to pay for the cost of institutional (nursing-home) care must reach Montana's DPHHS in writing within 30 days of the notice mailing, rather than the usual 90 days. If you are appealing a patient-liability figure for a nursing-home resident, mark that 30-day date.

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. MedicaidMontana Medicaid: A Guide for Seniors and FamiliesMontana Medicaid long-term care for seniors: the $2,000 asset limit, medically needy spend-down (no Miller Trust), Medicare Savings Programs, and how to apply. MedicaidYour Guide to Montana Medicaid Income and Asset LimitsMontana Medicaid income limits 2026: adults under 65 qualify to 138% FPL with no asset test; seniors and long-term care get a spend-down and a $2,000 limit. MedicaidMontana Medicaid and Nursing Home CareHow Montana Medicaid nursing home coverage works in 2026: eligibility, the asset limit, the spend-down income pathway, patient liability, and estate recovery. MedicaidMontana Medicaid Estate RecoveryMontana DPHHS can claim a deceased Medicaid recipient's home or farm, even property in joint tenancy or a beneficiary deed. See who is exempt from recovery.

Find personalized help preparing a Montana 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.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.