Medicaid appeals in New York: hearing deadline and keeping benefits

Medicaid (New York Medicaid) denials in New York

Medicaid agency

New York State Department of Health (DOH); local departments of social services (HRA in New York City); NY State of Health for many eligibility decisions

Who holds the hearing

NYS Office of Temporary and Disability Assistance (OTDA), Office of Administrative Hearings; eligibility notices sent by NY State of Health are heard by the NY State of Health Appeals Unit

Hearing deadline

60 days

The date of the action or notice you disagree with

Source: the notice says "60 days from the date of this notice"

If you are late

For NY State of Health notices, if you ask after 60 days the Appeals Unit will ask you to give a good cause reason for the late request.

How to ask for a hearing

• Phone: OTDA statewide toll-free 1-800-342-3334 (have your notice with you; TTY: call 711 and ask for 1-877-502-6155)
• Online: OTDA online fair hearing request form (link on your notice)
• Fax: Fax a copy of your notice to (518) 473-6735
• Mail: Fair Hearing Section, New York State Office of Temporary and Disability Assistance, P.O. Box 1930, Albany, New York 12201 (keep a copy)
• In person: OTDA Office of Administrative Hearings, 5 Beaver Street, New York, NY 10004, or 40 North Pearl Street, Albany, NY 12243
• Phone: For a notice from NY State of Health: call 1-855-355-5777, or send form DOH-5231 by upload to your account, fax 1-855-900-5557, or mail to NY State of Health Appeal Unit, P.O. Box 11729, Albany, NY 12211

otda.ny.gov · 1-800-342-3334

Mail address

Fair Hearing Section, New York State Office of Temporary and Disability Assistance, P.O. Box 1930, Albany, New York 12201

What to include

Send a completed copy of your notice and say why the agency's action is wrong. Include your name, case number, address, phone number and signature. Keep a copy for yourself.

Keeping your benefits during the appeal

If the agency had to give you advance notice, your Medicaid continues unchanged until the hearing decision (aid continuing) if you ask for a fair hearing before the effective date of the action on your notice. DOH guidance (GIS 25 MA/07) also accepts a request made within 10 days of the mailing of the notice, if that is later. For a notice from NY State of Health, coverage continues if you ask within 10 days of the date of the notice or before the effective date, whichever is later. If you lose, you may have to pay back the cost of benefits you got while waiting.

Law: 18 NYCRR 358-3.6(a)(1); DOH GIS 25 MA/07 (Aug. 1, 2025); N.Y. Soc. Serv. Law 22(4)(a); N.Y. Soc. Serv. Law 18 NYCRR 358-3.5, 358-3.6; DOH notice OHIP-3868

When the hearing is held

The fair hearing decision is made within 90 days of your request (DOH model managed care notices).

Law: DOH Model MMC/MLTC Final Adverse Determination notice (rev. 7/25); N.Y. Soc. Serv. Law 22(4)(a); N.Y. Soc. Serv. Law 18 NYCRR 358-3.5, 358-3.6; DOH notice OHIP-3868

Faster (expedited) hearing

If a delay would seriously risk your health, life or ability to function, you can ask OTDA for a fast track fair hearing and send information that shows why (you can upload it at upload.ny.gov). In New York City, emergency fair hearings can be requested at 1-800-205-0110. For NY State of Health eligibility appeals, ask in writing with a note from your medical provider (call 1-855-355-5777).

Law: N.Y. Soc. Serv. Law 22(4)(a); N.Y. Soc. Serv. Law 18 NYCRR 358-3.5, 358-3.6; DOH notice OHIP-3868

Ombudsman

Independent Consumer Advocacy Network (ICAN) · 1-844-614-8800

Medicaid health plan (managed care) in New York

Appeal to the plan first

Ask your plan for a Plan Appeal within 60 calendar days of the date of the notice, by phone, fax, mail or in person (email or online if the plan offers it). To keep your services the same during the Plan Appeal, ask within 10 calendar days or by the date the decision takes effect, whichever is later. The plan must decide within 30 calendar days, or 72 hours for a fast track appeal (up to 14 more days if more information is needed). If the plan says no, you have 120 calendar days from the Final Adverse Determination to ask OTDA for a fair hearing; to keep your services the same, ask within 10 days. Mail managed care hearing requests to OTDA, Office of Administrative Hearings, Managed Care Unit, P.O. Box 22023, Albany, New York 12201-2023, or fax 518-473-6735.

Then a state hearing

120 days

The date of the plan's Final Adverse Determination

If the plan is late

If the plan does not decide your Plan Appeal in time (including any extension), you can ask for a fair hearing without waiting.

Optional outside medical review

If the plan said the service was not medically necessary, experimental or investigational, or available in-network, you may also ask DFS for an External Appeal within 4 months of the Final Adverse Determination. For these denials, if the plan does not answer your Plan Appeal on time, the original denial is reversed. If you ask for both, the fair hearing decision is final.

Law: NYS DOH Model Medicaid Managed Care Notices (revised 7/25); DOH, Enrollee Right to Fair Hearing and Aid Continuing (Dec. 15, 2017); DOH, Enrollee Right to Fair Hearing and Aid Continuing (Dec. 42 CFR 438.402, 438.408, 438.420

Write my appeal: free letters

Letter: Medicaid fair hearing request