Medicaid appeals in New Jersey: hearing deadline and keeping benefits
NJ FamilyCare (Medicaid): you have 30 days to ask for a fair hearing.
Since July 1, 2026, benefits do not continue automatically. When you ask for a fair hearing, you must choose (elect) to keep your benefits at the same level while the hearing is pending.
Checked against official sources: October 30, 2026.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
Medicaid (NJ FamilyCare (Medicaid)) denials in New Jersey
- Medicaid agency
New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS), with county welfare agencies
- Who holds the hearing
New Jersey Office of Administrative Law (OAL) holds the hearing; the DMAHS Director issues the final agency decision
- Hearing deadline
30 days
The date on the notice
Source: the regulation gives 20 days from receipt of the notice; DMAHS adds 10 days for mailing, so notices say 30 days from the date on the notice
- How to ask for a hearing
- Mail: Send a written request saying you disagree with the decision, with a copy of your notice, to Division of Medical Assistance and Health Services, Attn: Fair Hearing Unit, P.O. Box 712, Trenton, NJ 08625
- Fax: DMAHS Fair Hearing Unit fax 609-588-2435
- Form: Follow the fair hearing instructions on your notice. The request must be made within 30 days of the date on the notice, with proof of mailing or faxing within that time.
- Mail address
Division of Medical Assistance and Health Services, Attn: Fair Hearing Unit, P.O. Box 712, Trenton, NJ 08625
- What to include
A written statement that you disagree with the decision, and a copy of your eligibility notice.
Law: N.J.A.C. 10:49-10.3(b)
- Keeping your benefits during the appeal
Since July 1, 2026, benefits do not continue automatically. When you ask for a fair hearing, you must choose (elect) to keep your benefits at the same level while the hearing is pending. If you do not elect it, your benefits are paused. If you keep benefits and lose, the state may recover the cost of services you got, generally not for the time after the first 90 days. If you choose to stop benefits and win, your benefits are restored back to the earlier date.
Law: N.J.A.C. 10:49-10.4(b); N.J.A.C. 42 CFR 431.230; N.J.A.C. 10:49-10.3(b)
Medicaid health plan (managed care) in New Jersey
- Appeal to the plan first
Appeal to your NJ FamilyCare health plan first, within 60 calendar days after the plan sends the denial letter. There is only one internal appeal level. If the plan says no, you can ask for a Medicaid Fair Hearing within 120 calendar days of the internal appeal denial letter, and you can also ask for an IHCAP external appeal within 60 days. To keep getting services during the fair hearing, ask within 10 calendar days of the plan's denial letter or by the end of your approved authorization, whichever is later.
- Then a state hearing
120 days
The date of the health plan's internal appeal denial letter
- Optional outside medical review
After the plan's internal appeal, you can also ask for an external appeal by an independent reviewer through DOBI's IHCAP within 60 days of receiving the plan's decision. To keep services during the external appeal, file by the last day of your approved authorization or within 10 calendar days of the plan's denial letter, whichever is later.
Law: 42 CFR 438.402, 438.408, 438.420
Write my appeal: free letters
Sources
The official sources for New Jersey are listed on the New Jersey page.