A Medicaid denial or termination notice is common, and it isn't the final word. You can ask for a Medicaid fair hearing, which is a review by a state official who wasn't part of the first decision. You can ask by phone, mail, in person, or online. Your exact deadline is printed on your notice.
Why was my Medicaid denied or ended?
Your notice has to name the action, the reason, and the rule behind it, under the federal Medicaid fair hearing rules (42 CFR Part 431, Subpart E). Most notices point to one of these reasons:
- Renewal paperwork didn't come back in time.
- The state says your income or household changed.
- A document was missing, like proof of income, residency, or citizenship.
- A service was denied. The state or plan may have said it wasn't medically necessary, or that prior authorization (advance approval before care) wasn't in place.
In many states, people who get Supplemental Security Income (SSI) get Medicaid automatically, so a change to SSI can end Medicaid too. See our guide on who can apply for SSI.
How long do I have to ask for a Medicaid fair hearing?
Each state sets its own deadline. The federal fair hearing rules say the state must give you a reasonable time, up to 90 days from the date the notice was mailed. Some states allow less, so go by your notice.
The clock starts on the mailing date, not the day you opened the letter. Managed care plans work differently (see below).
How do I request a Medicaid fair hearing, step by step?
- Read the notice closely. Find the action (denied, ended, or reduced), the reason, the effective date, and the hearing deadline.
- Decide if you want coverage to continue. If you do, ask before the effective date.
- Ask for the hearing. Under the federal fair hearing rules, states must accept requests by phone, mail, in person, and online. The contact details are on your notice. If you can't find them, Medicaid.gov's state overviews link to every state's program.
- Say what you disagree with, in plain words. "I disagree with ending my coverage because my income didn't change" is enough.
- Keep a record. Note dates, times, and names of everyone you talk to. Keep a copy of anything you mail or upload.
- Ask for a faster hearing if waiting could seriously harm your health. States must offer one when the usual timeline could risk your life, health, or ability to function.
- Watch your mail. Your hearing notice will list the date, the time, and whether it's by phone or in person.
Someone you choose can help or speak for you.
How do Medicaid managed care plan appeals work?
Many states run Medicaid through managed care plans, which are private health plans the state pays to handle your care. If your plan denied, cut, or stopped a service, you usually appeal to the plan first.
Federal managed care rules (42 CFR Part 438, Subpart F) set the basic order:
- You file an appeal with the plan by the deadline on the plan's denial notice.
- The plan decides within a set time. If waiting could seriously harm your health, ask for an expedited appeal, which the plan must decide faster.
- You can then ask for a state fair hearing if the plan says no again or doesn't decide on time. That deadline runs from the plan's decision and is listed in the plan's decision notice.
For example, say your plan stops the home health visits you've had for a year. You'd appeal to the plan, ask to keep the visits going, and request a state fair hearing if the plan upholds its decision. For more on coverage denials, browse our Health Advocate guides.
Can I keep my Medicaid coverage during the appeal?
Often, yes, if you act before the change takes effect. The federal fair hearing rules generally require the state to mail your notice at least 10 days before it ends or reduces your coverage. If you ask for a hearing before the effective date, the state generally can't end or reduce your benefits until the hearing decision.
In managed care, check the plan's notice for the deadline to ask for continued services, and say clearly that you want services to continue.
This applies only to existing coverage; a denied new application doesn't start coverage during the appeal.
If the hearing upholds the decision, the state may ask you to repay the cost of services you got during the appeal. Ask your agency how it handles this.
What should I bring to a Medicaid fair hearing?
You have the right to see your case file before the hearing, including the documents the agency used to decide, so ask for it early. At the hearing, you can bring witnesses, present evidence, and question the agency's evidence.
Bring:
- Your notice
- Proof tied to the reason on the notice, like pay stubs, bank statements, a lease, or ID
- For a service denial, a letter from your doctor explaining why you need the service, plus related records
- Your call log and copies of everything you sent
- A short list of the points you want to make
What mistakes should I avoid in a Medicaid appeal?
- Assuming a phone call counts as a hearing request. Say "I'm requesting a fair hearing," and ask for a confirmation number or letter.
- Missing the window to keep coverage. It's often much shorter than the hearing deadline.
- Sending original documents. Send copies and keep the originals.
- Letting your address go stale. Update it so hearing notices reach you.
- Treating a plan appeal and a state hearing as the same thing. They're separate steps with separate deadlines.
What if I missed the Medicaid fair hearing deadline?
You may still have options.
- Return your renewal form. If coverage ended because your renewal paperwork didn't come back, federal renewal rules (42 CFR 435.916) give you a period after coverage ends to return it, and the state must then reconsider without a new application. Ask your agency how long your state allows.
- Reapply. You can apply for Medicaid at any time, and a new application gets a new decision.
- Ask about good cause. Some states accept a late hearing request for a good reason, like a hospital stay. Rules vary, so ask your agency directly.
If you're also sorting out job-based coverage, our article on whether an employer can cancel your health insurance during disability covers that side.
What this means for you
- Find two dates on your notice today: the hearing deadline and the effective date.
- Request the hearing by phone, mail, in person, or online, and get a confirmation.
- Ask to keep your coverage before the effective date if you're losing coverage you already have.
- Gather proof that answers the exact reason on your notice.
More plain-language guides are on the Turnout blog at turnout.co.
FAQ
My Medicaid was denied. What do I do now?
Find the hearing deadline on your notice, then ask for a fair hearing using the contact details listed there. If a document was missing, also send it to your agency right away.
Why did my Medicaid coverage end at renewal?
Usually a renewal form didn't come back or arrived late. Check your notice for the reason, then ask your agency how long you have to return the missing form.
How long does a Medicaid fair hearing take?
The federal fair hearing rules say the state should generally make a final decision within 90 days of your request, and expedited hearings are decided faster.
Can my Medicaid managed care plan deny a service?
It can, and you can appeal. You usually appeal to the plan first, then ask for a state fair hearing if the plan says no again.
Can I appeal if HealthCare.gov said I don't qualify for Medicaid?
In some states, Medicaid eligibility decisions made through HealthCare.gov can be appealed through the Marketplace. HealthCare.gov's Marketplace appeals page explains how to file. Check your eligibility notice to see who made the decision.
Turnout is not a law firm and does not provide legal or tax advice.
It's your turn
While your hearing moves forward, it's worth checking which health coverage and other programs you may qualify for. Turnout's site is a good place to see how it can help. If you also have Medicare, Turnout's healthcare advocates can take on denied coverage and appeals on that side.