If Texas denied, reduced, or ended your Medicaid benefits, you have the right to appeal and request a fair hearing, and you can often keep those benefits in place while your appeal is decided.,,

Your appeal goes through the Texas Health and Human Services Commission (HHSC), which runs Texas Medicaid and holds fair hearings before an impartial hearings officer.

In This Guide

What You Can Appeal in Texas Medicaid

Federal law gives every Medicaid applicant and recipient the right to a fair hearing before the state agency whenever a claim is denied, is not acted on with reasonable promptness, or the agency makes an adverse determination. In Texas, the right to a fair hearing lets anyone who disagrees with an adverse action, meaning a denial, a reduction, or a termination, request a state fair hearing.

In practice, you can appeal:

  • A denial of your application on income, assets, or other eligibility grounds
  • A termination or reduction of your eligibility or of a covered service
  • A cut to your service hours, such as personal attendant or home care hours
  • A prior-authorization denial or another adverse determination on a service
  • A managed care plan's denial, reduction, or termination of a service

The right reaches across the program, from the first eligibility decision to a service cut years into your coverage.

The Deadlines That Decide Your Texas Medicaid Appeal

A Texas Medicaid appeal runs on several different deadlines, and they are not the same length. The shortest of them is the one that keeps your benefits in place while the appeal is decided.

The request window is 90 days for an HHSC action and 120 days for a managed care action, and the two are measured from different events. In Texas you must request a fair hearing within 90 calendar days from the date of the action or the effective date on your Notice of Case Action, and within 120 days for an action taken by a managed care organization. For agency actions, federal law sets 90 days from the date the notice is mailed as the ceiling, under 42 CFR 431.221(d)., The managed care window is longer because a different rule governs it: 42 CFR 438.408(f)(2) requires the state to allow no less than 90 and no more than 120 calendar days from the date of the plan's notice of resolution, and Texas allows the full 120., So the 120 days does not start when the plan first denied you; it starts when the plan tells you it is upholding that denial. A request filed after the deadline is reviewed for good cause, so file as soon as you can and say why it is late.

The decision deadline is 90 days. After you request a hearing, HHSC must ordinarily issue its final decision and take final administrative action within 90 days of receiving the request, under 42 CFR 431.244(f)(1); shorter timeframes apply to expedited hearings.

There is also a renewal safety valve. If your coverage ended only because you did not return a renewal form on time, federal law requires the agency to reconsider your eligibility without a new application if you provide the renewal form within 90 days of the termination date. 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, Texas may offer the same window but is not required to, so ask HHSC.

How to Keep Your Benefits During a Texas Medicaid Appeal

Continuation of benefits, often called aid paid pending, is never automatic, and the deadline that triggers it is earlier than the deadline to appeal.

Under 42 CFR 431.230(a), if the agency sent the required 10-day or 5-day advance notice and you request the hearing before the date the action takes effect, the agency may not terminate or reduce your services until a decision is rendered after the hearing, unless the sole issue is one of federal or state law or policy. In Texas, that means requesting the fair hearing before the effective date shown on page 1 of your notice (Form 2065-A) to keep your services at the current level during the appeal.

If you miss that date, continuation under 431.230 is off the table, but a separate provision may still help: under 42 CFR 431.231, the agency may reinstate services if you request a hearing not more than 10 days after the date of action.

If a STAR+PLUS plan took the action, you can ask to keep services at the current level while the plan appeal and any later fair hearing are pending. Your request counts as timely if you file it by the later of two dates: 10 calendar days after the plan sends the notice of adverse benefit determination, or the intended effective date of the action. It is not a flat 10-day cutoff, so if the effective date is further out, your window is still open.

One caution applies either way, though how far it reaches differs. On the agency side, if the action is later sustained, 42 CFR 431.230(b) lets the agency recoup the cost of services furnished solely by reason of the continuation. It is not a bill for everything you received while the appeal ran. On the managed care side, if the final resolution upholds the plan, the plan may recover the cost of the services furnished to you while the appeal and state fair hearing were pending. Your plan's notice has to spell out, up front, the circumstances under which you may be required to pay for continued services.

Managed Care (STAR+PLUS) Appeals: Exhaust Your Plan First

Texas delivers Medicaid for most aged and disabled adults through STAR+PLUS, its managed care program, which is served by seven managed care organizations (MCOs) under the contracts that took effect September 1, 2024., On HHSC's service area map of the plans serving clients as of January 2026, the STAR+PLUS lines name Superior, Wellpoint, Molina, United, Community First, El Paso Health, and Community Health Choice. HHSC prints some of those names differently on its provider relations contact list, where the same plans appear as UnitedHealthcare, El Paso First, and Community First Health Plan, so do not be thrown if your paperwork uses a longer form. Wellpoint is the plan Amerigroup rebranded to on January 1, 2024. When your plan denies, reduces, or ends a service, you appeal to the plan before you can reach a state fair hearing.

Under 42 CFR 438.404, the MCO must give you timely written notice of an adverse benefit determination. That notice must explain the determination and its reasons, how to appeal and exhaust the plan's one internal appeal before you request a state fair hearing, and your right to have benefits continue during the appeal and how to request continuation.

You have 60 calendar days from the date on the determination notice to file the plan's internal appeal, and you can request it either orally or in writing. The plan is contractually required to treat any oral or written expression of dissatisfaction as a request to appeal, so you do not have to phrase it a particular way., Texas must set a standard resolution timeframe no longer than 30 calendar days from the day the plan receives your appeal; that can be extended by up to 14 calendar days if you ask for the extension or the plan shows HHSC it needs more information and the delay is in your interest. An expedited appeal must be resolved within 72 hours when waiting on the standard timeline could seriously jeopardize your health.

You must finish the plan's one internal appeal before you request a state fair hearing. There is one built-in exception: if the plan fails to meet the notice and timing rules, you are deemed to have exhausted its appeals process and may go straight to a hearing., After the plan mails a decision that upholds its action, you have 120 days to request the state fair hearing, and HHSC's hearings officer has 60 to 90 days from the appeal request date to issue a written decision.,

The two pathways differ mainly in whether you have to appeal to a plan first:

Step Agency (fee-for-service) action Managed care (STAR+PLUS) action
Where you appeal first HHSC state fair hearing Your MCO's internal appeal
Deadline to file 90 days from the date of action 60 days to file the MCO appeal
Internal step required first None Yes, exhaust the MCO appeal
Deadline for a state fair hearing 90 days from the action 120 days after the MCO's appeal decision notice
Decision timeline HHSC decides within 90 days of your request MCO resolves within 30 days, then HHSC decides in 60 to 90 days
Keeping benefits Request before the effective date on the notice Request by the later of 10 days after the plan's notice or the action's effective date

How to Request a Fair Hearing in Texas

HHSC's Fair and Fraud Hearings office conducts a Texas Medicaid fair hearing before an impartial hearings officer. You can request one in writing, by calling 2-1-1, or by visiting a local HHSC office; a verbal or written request is accepted, and you can also return Form 2065-A with the appropriate box checked.

Hearings are typically held by conference call. If you remain dissatisfied after the hearing process, you can contact the HHS Office of the Ombudsman for help.

Whichever method you use, keep a copy of your request and note the date you filed it.

Frequently Asked Questions

How long do I have to appeal a Texas Medicaid denial?

You have 90 calendar days from the date of the action, or the effective date on your Notice of Case Action, to request a fair hearing, and 120 days for an action taken by a managed care organization (MCO). For an MCO denial the sequence matters: you first have 60 calendar days to file the plan's internal appeal, and the 120-day fair-hearing window then runs from the date the plan mails its decision on that appeal, not from the original denial.

Can I keep my Medicaid benefits while I appeal?

Yes, if you request the hearing before the effective date shown on your notice and ask for your benefits to continue. Under 42 CFR 431.230(a), your services then continue until a decision is issued after the hearing, and if the action is later sustained, 431.230(b) lets the agency recoup only the cost of services furnished solely by reason of that continuation. If a STAR+PLUS plan took the action, file for continuation by the later of 10 calendar days after the plan sends its notice or the intended effective date of the action; if the final resolution upholds the plan, it may recover the cost of the services furnished while the appeal and hearing were pending. Either way, continuation is not automatic. You have to ask.

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

You are not required to hire a lawyer. You can request and handle a Texas Medicaid fair hearing yourself, because the person appealing may make a verbal or written request. Representation can still help for complex disputes, such as a level-of-care or prior-authorization denial, but the choice is yours.

What if I miss the deadline to appeal?

A late request is reviewed for good cause, so file as soon as you can and explain why it is late. If your coverage ended only because you missed a renewal deadline, you may not need to appeal at all: federal law requires the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination date (required for MAGI-based coverage; a state option otherwise).

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. MedicaidTexas Medicaid: The Complete GuideTexas Medicaid for seniors: 2026 income and asset limits, the STAR+PLUS managed-care program, HCBS waivers, Medicare Savings Programs, and how to apply. MedicaidTexas Medicaid Managed Care PlansCompare Texas Medicaid managed care plans for STAR+PLUS seniors. See which MCOs serve your area, how to switch plans, and what to look for when choosing. MedicaidTexas STAR+PLUS Waiver ProgramTexas STAR+PLUS covers Medicaid managed care for seniors 65+. The HCBS waiver income limit is $2,982/month, and Community First Choice has no waitlist. MedicaidTexas Medicaid Estate RecoveryHow Texas Medicaid estate recovery (MERP) works in 2026: probate-only scope, the $10,000 threshold, homestead and family exemptions, and hardship waivers.

Find personalized help navigating a Texas 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.