If your Nebraska Medicaid coverage was denied, reduced, 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., Medicaid is a joint federal and state program, so both a federal framework and Nebraska's own process govern your appeal. You have up to 90 days from the date your notice was mailed to request a fair hearing, and a shorter 10-day window to keep your current benefits flowing while the case is pending. A Nebraska Medicaid appeal runs through the Nebraska Department of Health and Human Services (DHHS), and for a managed care denial it starts with your Heritage Health plan before it reaches a state fair hearing.

In This Guide

What You Can Appeal in Nebraska 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 and the implementing regulation at 42 CFR 431.220 require Nebraska 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 Nebraska, that hearing is a state fair hearing conducted by DHHS, and it applies whether your coverage runs through fee-for-service Medicaid or a Heritage Health managed care plan.

In practice, you can appeal any DHHS action that affects your benefits, including:

  • An application denial (income, assets, or documentation)
  • A termination or reduction of eligibility or covered services
  • A cut in authorized service hours, such as home care or personal assistance
  • A prior-authorization denial or a level-of-care determination
  • A renewal or recertification denial
  • A managed care plan's denial, reduction, suspension, or termination of a service

The right reaches across the program. If you disagree with any action DHHS took that affects your benefits, the fair-hearing process is how you challenge it.

Nebraska Medicaid Appeal Deadlines That Decide Your Case

Several deadlines govern a Nebraska Medicaid appeal, and they are not the same number. The table below lines them up; the mechanics follow.

Window What it protects When the clock starts
90 days Your right to request a fair hearing Date the notice of action was mailed
10 days Continuation of your current benefits during the appeal Date of the agency notice
60 calendar days Your right to file a Heritage Health plan's internal appeal Date on the plan's adverse benefit determination notice
90 to 120 calendar days Your right to a state fair hearing after a plan appeal Date of the plan's notice of resolution
90 days Reconsideration of a lapsed renewal without reapplying The termination date

A fair-hearing request must be made within 90 days of the action or inaction you are challenging. Nebraska follows the federal ceiling under 42 CFR 431.221(d), which allows a reasonable time not to exceed 90 days from the date the notice of action is mailed, and the state does not impose a shorter window of its own., The mail date itself is not counted, and if the ninetieth day falls on a Saturday, Sunday, or state holiday, the deadline extends to the next business day.

To keep your current benefits flowing while the appeal is pending, you must request the hearing within 10 days of the date of the agency notice, not 90. This shorter, more urgent window is covered in the next section.

If your denial came from a Heritage Health plan, you have 60 calendar days from the date on the adverse benefit determination notice to file the plan's internal appeal. After the plan resolves that appeal against you, the state must give you no less than 90 and no more than 120 calendar days from the date of the plan's notice of resolution to request a state fair hearing; the exact number within that band is set by the state.

One more deadline protects renewals. If your coverage ended only because you did not return a renewal form or requested information on time, you do not always have to reapply: under 42 CFR 435.916, if you submit the form or the missing information within 90 days after the termination date, the agency must reconsider your eligibility without a new application.

How to Keep Your Benefits During a Nebraska Medicaid Appeal

Keeping your benefits during an appeal is called continuation of benefits, or "aid paid pending." In Nebraska it is not automatic in the way many people assume, and a single deadline controls it.

You may continue to receive your current level of assistance until a hearing decision is made if you request the hearing within 10 days from the date of the agency notice. DHHS provides a petition form, Form DA-6 (Notice and Petition for Fair Hearing), and on that form continuation is the default: your benefits continue unless you affirmatively check the box to waive it. If you check that box, your assistance is discontinued or reduced until the appeal decision is made.

Nebraska's 10-day rule implements the federal continuation regulation at 42 CFR 431.230(a), under which the agency may not terminate or reduce services after a timely pre-action hearing request, unless the sole issue is one of federal or state law or policy. When an adverse-action notice arrives, act inside the 10-day window, and do not waive continuation on the form unless you mean to.

Managed Care (MCO) Appeals in Heritage Health

Nebraska delivers most medical, behavioral health, dental, vision, and pharmacy benefits through managed care. Under the Heritage Health program, three statewide managed care organizations (MCOs) contract with the state: Nebraska Total Care, UnitedHealthcare Community Plan of Nebraska, and Molina Healthcare of Nebraska. When one of these plans denies care, you appeal to the plan before you reach a state fair hearing. These rules come from the federal managed care regulations at 42 CFR Part 438.

Under 42 CFR 438.404, the plan must give you timely, written notice of an adverse benefit determination, which includes a denial or limited authorization of a service, a reduction or termination of a previously authorized service, a denial of payment, or a failure to act within required timeframes. That notice must tell you how to appeal, how to request an expedited appeal, and how to ask that your benefits continue during the appeal.

You have 60 calendar days from the date on the determination notice to file the plan's internal appeal. A Heritage Health plan has one level of appeal, and you must exhaust it before requesting a state fair hearing. The plan must resolve a standard appeal within 30 calendar days and an expedited appeal within 72 hours, though either timeframe can be extended by up to 14 calendar days when you request the extension or the plan shows the state that more information is needed and the delay is in your interest.

Once the plan resolves your appeal, you may request a state fair hearing from DHHS, and Nebraska also offers an External Medical Review under 42 CFR 438.402(c). If the plan fails to meet the notice and timing rules, the appeal is deemed exhausted and you may go straight to a state fair hearing., You then have 90 to 120 days from the plan's notice of resolution, the exact number set by the state, to request the hearing.

Long-term care is carved out of managed care, so there is no plan appeal to exhaust, a distinction that matters most to older adults. Long-term care and home and community-based services (HCBS) waiver services, State Plan personal assistance, and nursing-facility or intermediate care facility for people with developmental disabilities (ICF-DD) care are excluded from Heritage Health managed care and paid under fee-for-service. Participants in the Program of All-Inclusive Care for the Elderly (PACE) and certain other members are not enrolled in a Heritage Health plan at all. A denial of those long-term-care or waiver services is a DHHS action you appeal directly through the fair-hearing process, with no MCO internal appeal to complete first.

How to Request a Fair Hearing in Nebraska

Fair hearings are conducted by the DHHS Hearing Office, within DHHS Legal Services, in Lincoln. For program details, see Nebraska Medicaid and Long-Term Care. The written request is a petition to the Director of Health and Human Services. Here is how to file:

1
Step 1

Put your request in writing

A fair-hearing request must be made in writing. DHHS provides Form DA-6 (Notice and Petition for Fair Hearing), but the DA-6 is not required, and any form of written correspondence must be accepted.

2
Step 2

File within the deadline

Send your request within 90 days of the action, and within 10 days if you want your current benefits to continue while the appeal is decided.

3
Step 3

Send it to the DHHS Hearing Office

You can email the DHHS Hearing Office at DHHS.HearingOffice@nebraska.gov. Hearings are held at the DHHS Hearing Office in Lincoln and can be attended in person or by telephone at a scheduled date and time.

4
Step 4

Bring your evidence, and a representative if you want one

You may present your own case or be represented by another person, such as legal counsel, a relative, a friend, or another spokesperson.

DHHS conducts the hearing, reaches a decision, and notifies the parties by written order.

Frequently Asked Questions

What happens if I miss the Nebraska Medicaid appeal deadline?

If you do not request a fair hearing within 90 days of the date your notice was mailed, you generally lose the right to a hearing on that action. One narrower cushion survives: if your coverage lapsed only because you missed a renewal form or a request for information, submitting it within 90 days of the termination date forces the agency to reconsider your eligibility without a new application. And because the window to keep your benefits is only 10 days, waiting even a few weeks can cost you coverage during the appeal, so file as soon as the notice arrives.

Does keeping my benefits mean my coverage stays exactly as it was?

Yes. If you request the hearing within 10 days of the date of the agency notice, your current level of assistance continues until a decision is made, so a proposed reduction does not take effect and a termination does not go through while the appeal is pending. That protection holds only if you do not check the waiver box on the DA-6 petition form. It implements the federal continuation rule at 42 CFR 431.230(a).

Do I need a lawyer for a Nebraska Medicaid fair hearing?

No. You may present your own case or be represented by another person, including legal counsel, a relative, a friend, or another spokesperson. Representation can help with level-of-care and complex prior-authorization disputes. Free or low-cost civil legal help is available from Legal Aid of Nebraska for qualifying applicants.

What is the difference between a Heritage Health plan appeal and a state fair hearing?

A Heritage Health plan appeal is the internal appeal you file with your managed care organization (MCO), and it is the required first step for a managed care denial. The plan must resolve a standard appeal within 30 calendar days or an expedited appeal within 72 hours. A state fair hearing is the separate review DHHS conducts after the plan resolves its appeal, and you have 90 to 120 days from the plan's resolution notice to request it. For long-term-care and waiver services, which are outside Heritage Health, you skip the plan appeal and request the DHHS fair hearing directly.

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. MedicaidNebraska Medicaid: A Guide for Seniors and FamiliesNebraska Medicaid covers long-term care for seniors via DHHS spend-down: the $4,000 asset limit, MSPs, estate recovery, and how to apply in 2026. MedicaidHow to Apply for Nebraska MedicaidHow to apply for Nebraska Medicaid online, by phone, or in person: iServe Nebraska, asset limits, spend-down, documents, timelines, and how to appeal a denial. MedicaidHow to Get on a Nebraska Medicaid HCBS WaiverNebraska Medicaid HCBS waivers cover home and community care through the Aged and Disabled (AD) Waiver for adults 65+ and people with physical disabilities.

Find personalized help navigating a Nebraska 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.