Medicaid fair hearings and keeping your benefits

If Medicaid denies, cuts or ends your coverage or a service, you can ask for a fair hearing with the state. Federal law sets the outer limits; each state sets its own deadline within them.

Checked against official sources: October 30, 2026.

Notice before a change

  • Before it cuts or ends your benefits, the state must usually send you a notice at least 10 days before the change takes effect.

Law: 42 CFR 431.211

Asking for a fair hearing

  • Your state must give you a reasonable time to ask for a fair hearing, up to 90 days from the date the notice was mailed. Check your notice: your state's deadline may be shorter.

    Law: 42 CFR 431.221(d)

  • You can ask for a hearing by mail or in person. Many states also take requests by phone or online; your notice lists the ways your state accepts. You can ask for a faster (expedited) hearing in the same request. The state may not stop you from asking, and it may help you make the request.

    Law: 42 CFR 431.221(a)-(c); 42 CFR 435.907(a); 42 CFR 435.1200(i)

  • The state must ordinarily make a final decision within 90 days of your hearing request. If you first appealed to a Medicaid managed care plan, the 90 days count from the date you filed the plan appeal, not counting the days you took to ask for the hearing. Expedited hearings about a denied service from a managed care plan must be decided within 3 working days after the state gets the plan's case file.

    Law: 42 CFR 431.244(f)(1)-(2)

  • Before and during the hearing you can see your case file and the documents the agency will use, bring witnesses, and question the evidence.

    Law: 42 CFR 431.242

Keeping your benefits while you wait

  • If you ask for a hearing before the date the change takes effect, the state usually may not cut or end your services until the hearing decision. If you lose the hearing, the state may try to recover the cost of services you got only because of this rule.

    Law: 42 CFR 431.230

  • If you ask within 10 days after the change took effect, the state may restore your services until the decision. It must restore them if it did not send proper advance notice and you ask within 10 days of receiving the notice, unless the only issue is a change in federal or state law or policy. The notice counts as received 5 days after its date unless you show otherwise.

    Law: 42 CFR 431.231

  • States must offer an expedited hearing when the normal timeline could put your life, health or ability to regain maximum function at risk.

    Law: 42 CFR 431.224(a)

If you are in a Medicaid health plan

  • If you are in a Medicaid managed care plan, you first appeal to the plan. You have 60 calendar days from the date on the plan's notice. You can appeal orally or in writing. Plans may have only one appeal level.

    Law: 42 CFR 438.402(b), (c)(2)(ii), (c)(3)(ii)

  • The plan must decide within 30 calendar days, or 72 hours for an expedited appeal. It can add up to 14 days if you ask or if it shows the delay is in your interest.

    Law: 42 CFR 438.408(b)-(c)

  • If the plan says no, you can ask for a state fair hearing. Your state gives you 90 to 120 calendar days from the date of the plan's decision notice. If the plan misses its deadlines, you can go straight to a hearing.

    Law: 42 CFR 438.408(c)(3), (f)

  • If the plan is cutting or stopping a service you already had approved, you can keep getting it during the appeal if you ask for continued benefits within 10 calendar days of the plan sending its notice, or by the date the change takes effect, whichever is later. If you lose, the plan may be able to recover the cost under your state's rules.

    Law: 42 CFR 438.420

  • Some states also offer an optional, free independent medical review. It cannot replace or delay your right to a fair hearing.

    Law: 42 CFR 438.402(c)(1)(i)(B)

Medicaid hearing deadline by state

More →

Before you act

Read your notice for the hearing deadline and the number to call. If you want your benefits to continue, ask for the hearing as early as you can.

Quick answers

How long do I have to ask for a Medicaid fair hearing?

Your state must give you a reasonable time to ask for a fair hearing, up to 90 days from the date the notice was mailed. Check your notice: your state's deadline may be shorter.

Can I keep my benefits while I appeal?

If you ask for a hearing before the date the change takes effect, the state usually may not cut or end your services until the hearing decision.

What if I am in a Medicaid health plan?

If you are in a Medicaid managed care plan, you first appeal to the plan. You have 60 calendar days from the date on the plan's notice. You can appeal orally or in writing.

Free help

Free help can look at your denial and your letters. Consumer assistance programs, legal aid groups and state insurance departments do not charge for this.

Free calculator and letters

Appeal deadline calculator

Letter: appeal to your plan

Letter: ask for external review

Letter: Medicaid fair hearing request

Sources