How to appeal a Medicaid denial
The short answer
If a Medicaid health plan denied your care, you have 60 calendar days from the date on the notice to appeal to the plan, and then a state fair hearing if it says no again. If your state Medicaid agency made the decision directly, you ask for a fair hearing, usually within 90 days of the notice being mailed.
Deadlines, decision times and your rights
These are the limits in the federal rules. Your plan can give you more time but not less. If your denial letter prints an earlier date, go by the earlier one.
Deadline to appeal
60 days from the date printed on the denial notice
Rule: 42 CFR 438.402(c)(2)(ii)
What the rule says
Following receipt of a notification of an adverse benefit determination by an MCO, PIHP, or PAHP, an enrollee has 60 calendar days from the date on the adverse benefit determination notice in which to file a request for an appeal to the managed care plan.
Within 10 days of the plan sending the notice, or by the date the cut takes effect, whichever is later
Rule: 42 CFR 438.420(a)
What the rule says
Timely files means files for continuation of benefits on or before the later of the following: (i) Within 10 calendar days of the MCO, PIHP, or PAHP sending the notice of adverse benefit determination. (ii) The intended effective date of the MCO's, PIHP's, or PAHP's proposed adverse benefit determination.
Up to 90 days from the date the notice was mailed; your state may set a shorter deadline
Rule: 42 CFR 431.221(d)
What the rule says
The agency must allow the applicant or beneficiary a reasonable time, not to exceed 90 days from the date that notice of action is mailed, to request a hearings.
If you request a hearing before the date of action on your notice, services cannot be cut until the hearing decision
Rule: 42 CFR 431.230(a)
What the rule says
If the agency sends the 10-day or 5-day notice as required under § 431.211 or § 431.214 of this subpart, and the beneficiary requests a hearing before the date of action, the agency may not terminate or reduce services until a decision is rendered after the hearing unless
How long they have to decide
30 days after the plan receives your appeal (your state may require faster)
Rule: 42 CFR 438.408(b)(2)
What the rule says
For standard resolution of an appeal and notice to the affected parties, the State must establish a timeframe that is no longer than 30 calendar days from the day the MCO, PIHP, or PAHP receives the appeal. This timeframe may be extended under paragraph (c) of this section.
72 hours after the plan receives your urgent appeal (your state may require faster)
Rule: 42 CFR 438.408(b)(3)
What the rule says
For expedited resolution of an appeal and notice to affected parties, the State must establish a timeframe that is no longer than 72 hours after the MCO, PIHP, or PAHP receives the appeal. This timeframe may be extended under paragraph (c) of this section.
Ordinarily within 90 days after the agency receives your hearing request
Rule: 42 CFR 431.244(f)
What the rule says
The agency must take final administrative action as follows: (1) Ordinarily, within 90 days from: (i) The date the enrollee filed an MCO, PIHP, or PAHP appeal, not including the number of days the enrollee took to subsequently file for a State fair hearing; or (ii) For all other fair hearings, the date the agency receives a request for a fair hearing in accordance with § 431.221(a)(1).
The next level
At least 90 days (up to 120, set by your state) from the date of the plan's appeal decision
Rule: 42 CFR 438.408(f)(2)
What the rule says
The enrollee must have no less than 90 calendar days and no more than 120 calendar days from the date of the MCO's, PIHP's, or PAHP's notice of resolution to request a State fair hearing.
Within 10 days after the plan sends its appeal decision, request both the fair hearing and continued benefits
Rule: 42 CFR 438.420(c)(2)
What the rule says
The enrollee fails to request a state fair hearing and continuation of benefits within 10 calendar days after the MCO, PIHP, or PAHP sends the notice of an adverse resolution to the enrollee's appeal under § 438.408(d)(2).
Your rights along the way
- You can appeal by phone. You may request a Medicaid plan appeal orally or in writing. 42 CFR 438.402(c)(3)(ii)
- If the plan misses its deadline, go straight to a state fair hearing. If the plan fails the notice or timing rules, you are treated as having finished the plan appeal. 42 CFR 438.408(c)(3)
- Get your case file free, before the decision. The plan must give you your case file, medical records and any new evidence, free and in time to respond. 42 CFR 438.406(b)(5)
- Present evidence and testimony in person or in writing. You get a reasonable chance, in person and in writing, to present evidence and testimony and make arguments. 42 CFR 438.406(b)(4)
- The denial must give reasons and offer free copies of documents. The notice must explain the reasons and your right to free copies of all relevant documents, including medical necessity criteria. 42 CFR 438.404(b)(2)
- 10 days' advance notice before Medicaid cuts services. The agency must send notice at least 10 days before reducing or ending your benefits (limited exceptions). 42 CFR 431.211
- Ask for an expedited fair hearing. The state must offer a faster hearing when the normal timeline could jeopardize your life, health or function. 42 CFR 431.224(a)(1)
Each rule links to its text in the Electronic Code of Federal Regulations. Checked against the regulation text on November 10, 2026. The Lamdis app works out your dates from these same rules.
Two kinds of Medicaid, two starting points
In many states, Medicaid members are enrolled in a health plan run by a private company, called a managed care plan. If your denial letter comes from that kind of plan, start with an appeal to the plan.
If the decision came from your state Medicaid agency itself, often called fee-for-service, you go straight to a state fair hearing. The agency must give you a reasonable time to ask, no more than 90 days from the date the notice was mailed (42 CFR 431.221(d)).
Appealing to a Medicaid health plan
- Appeal to the plan within 60 calendar days from the date on the notice (42 CFR 438.402(c)(2)(ii)). The plan must decide within 30 calendar days, or 72 hours for an expedited appeal (42 CFR 438.408(b)).
- State fair hearing. If the plan keeps its denial, your state gives you between 90 and 120 calendar days from the plan’s decision to ask for a hearing; the notice will say which (42 CFR 438.408(f)(2)).
If the plan misses its deadlines or does not follow the notice rules, you are treated as having finished the plan appeal and can ask for a fair hearing right away (42 CFR 438.408(c)(3)).
Keep your services while you appeal
If the plan is cutting or ending a service you already receive, you can ask to keep getting it during the appeal. You must ask within 10 calendar days of the notice being sent, or before the change takes effect, whichever is later (42 CFR 438.420(a)). Read the notice for the exact date, and ask in writing.
The fair hearing decision
The state ordinarily must decide within 90 days (42 CFR 431.244(f)(1)). Expedited hearings for urgent cases move faster.
Questions people ask
How long do I have to appeal to my Medicaid plan?
60 calendar days from the date on the denial notice (42 CFR 438.402(c)(2)(ii)).
When can I ask for a state fair hearing?
After your plan decides your appeal, or right away if the plan missed its deadlines. Your state sets a deadline between 90 and 120 days from the plan’s decision.
Will my services stop while I appeal?
Not if you ask to continue them in time: within 10 calendar days of the notice being sent, or before the change takes effect, whichever is later.
Sources
- eCFR: 42 CFR 438.402, General requirements (Medicaid managed care grievances and appeals)
an enrollee has 60 calendar days from the date on the adverse benefit determination notice in which to file a request for an appeal
- eCFR: 42 CFR 438.408, Resolution and notification: Grievances and appeals
The enrollee must have no less than 90 calendar days and no more than 120 calendar days from the date of the MCO's, PIHP's, or PAHP's notice of resolution to request a State fair hearing.
- eCFR: 42 CFR 438.420, Continuation of benefits while the appeal and State fair hearing are pending
Within 10 calendar days of the MCO, PIHP, or PAHP sending the notice of adverse benefit determination.
- eCFR: 42 CFR 431.221, Request for hearing
a reasonable time, not to exceed 90 days from the date that notice of action is mailed, to request a hearings
- eCFR: 42 CFR 431.244, Hearing decisions
Ordinarily, within 90 days from
This page is general information about appeal rules in the United States. It is not legal or medical advice. Rules can change, and your plan’s documents and your denial letter control the dates that apply to you.