Medicaid appeals in Delaware: hearing deadline and keeping benefits

Medicaid (Delaware Medicaid (Diamond State Health Plan) and Delaware Healthy Children Program) denials in Delaware

Medicaid agency

Delaware Health and Social Services: Division of Medicaid & Medical Assistance (DMMA) and Division of Social Services (DSS)

Who holds the hearing

DSS Fair Hearing Office (DSS hearing officers)

Hearing deadline

90 days

The date on the notice of action (the date it was mailed)

How to ask for a hearing

• Email: DHSS_DSS_FHRequest@delaware.gov
• In person: At your local DHSS office
• Mail: To DMMA or DSS at the address on your notice (you can use the hearing request section of the notice)
• Fax: To the fax number on your notice
• Phone: Call DMMA or DSS at the number on your notice

What to include

The notice's request section asks for your case number, says "I am asking for a fair hearing. I disagree with this notice," and lets you choose whether to keep your current benefits until the hearing is decided.

Keeping your benefits during the appeal

Your Medicaid continues until the hearing decision if your hearing request is received during the timely notice period, the 10 days between the date the notice is mailed and the date the change takes effect. If the hearing officer upholds the action, the agency may recover the cost of benefits you got while waiting.

Law: DSSM 5300 (timely notice), 5305(A), 5308; DSSM 5000 (Fair Hearing Practice and Procedures), secs. 5304.3, 5305, 5308, 5500; DMMA Administrative Notice A-13-2025 (Nov. 13, 2025); 42 CFR 431.221(d)

When the hearing is held

The hearing officer must make a final decision within 90 days from the date the hearing request is filed. A request counts as filed when it is received by the hearing office, not when it is mailed.

Law: DSSM 5305(1), 5500; DSSM 5000 (Fair Hearing Practice and Procedures), secs. 5304.3, 5305, 5308, 5500; DMMA Administrative Notice A-13-2025 (Nov. 13, 2025); 42 CFR 431.221(d)

Faster (expedited) hearing

An expedited fair hearing is available for Medicaid and the Delaware Healthy Children Program when the standard timeframe could seriously jeopardize your life or health or your ability to attain, maintain or regain maximum function, for a decision to end, reduce or suspend services or to deny or limit a new service. The decision is due within 3 working days after the request is received.

Law: DSSM 5000 (Fair Hearing Practice and Procedures), secs. 5304.3, 5305, 5308, 5500; DMMA Administrative Notice A-13-2025 (Nov. 13, 2025); 42 CFR 431.221(d)

Medicaid health plan (managed care) in Delaware

Appeal to the plan first

If you are in a Medicaid managed care organization, appeal to the MCO first. The MCO must decide within 30 days, or within 72 hours for an expedited appeal when waiting could seriously jeopardize your life, health or ability to attain, maintain or regain maximum function. If it denies an expedited request, it decides in the standard 30 days and must tell you in writing within 2 calendar days. You can then ask DSS for a fair hearing within 120 calendar days of the MCO's appeal decision. The DSS hearing officer's decision is final for DHSS and binding on the MCO.

Then a state hearing

120 days

The date of the MCO's notice of appeal resolution

If the plan is late

If the MCO does not follow the federal notice and timing rules for appeals, you are treated as having finished its appeal process and can ask for a state fair hearing within 120 calendar days.

Law: DSSM 5304.3, 5305(E)

Write my appeal: free letters

Letter: Medicaid fair hearing request