Appeal deadlines in Pennsylvania

State outside review (4 months); Medicaid hearing deadline 30 days.

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.

Deadlines at a glance in Pennsylvania

Outside review: 4 months
Hearing deadline: 30 days
Then a state hearing: 120 days
Appeal deadline – Pennie: 90 days

How each deadline is counted in Pennsylvania

Time to file

State law follows the federal internal appeal rules. Use the deadline on your denial notice; federal rules give at least 180 days.

Law: 40 P.S. 991.2141, 991.2142, 991.2164 (Act 146 of 2022)

Deadline to ask

You must ask for an Independent External Review within 4 months after you receive the denial notice (usually the 'Final Adverse Benefit Determination Letter').

Law: 40 P.S. 991.2164.1-991.2164.14 (Act 146 of 2022, effective January 1, 2024)

The deadline runs from

The date you received the notice of the adverse benefit determination or final adverse benefit determination

Hearing deadline

The date of the written notice of the decision or action.

Keeping your benefits during the appeal

If DHS plans to reduce or end your Medical Assistance, the advance notice gives a date 10 calendar days after the notice was mailed. If your appeal is received or postmarked by that date, your benefits continue until the hearing decision unless you say you do not want them continued.

How long do I have? Deadline calculator

Pennsylvania · Appeal deadline calculator

If you miss a deadline

Medicaid

If no written notice was sent, you have 60 days from the action. If the office failed to send a required notice or made an administrative error, you have 6 months from the action; after 6 months you can still appeal in writing with a signed statement that you did not know your appeal rights or thought the problem was being fixed, that you believe the office was wrong, and that you appeal in good faith.

Law: 55 Pa. Code 275.3, 275.4

Sources

The official sources for Pennsylvania are listed on the Pennsylvania page.

National rules that apply in every state

You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal. Your plan can give you more time, not less.

Law: 29 CFR 2560.503-1(h)(3)(i); 45 CFR 147.136(b)(2)(i), (b)(3)(i)

Under the federal process you have 4 months from the date you receive the denial or final appeal decision to ask for external review. If there is no matching date 4 months later, the deadline is the first day of the fifth month. If the last day is a Saturday, Sunday or federal holiday, it moves to the next business day. State programs must allow at least 4 months; some allow more.

Law: 45 CFR 147.136(c)(2)(vi), (d)(2)(i)

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 generally have 90 days from the date of your Eligibility Notice to appeal. If you are late, explain why when you file; you may be able to get an extension.

Law: 45 CFR 155.520(b), (d)(2)(i)(D); HealthCare.gov, What can I appeal?