Medicaid appeals in Pennsylvania: hearing deadline and keeping benefits
Medical Assistance (Medicaid); HealthChoices managed care: you have 30 days to ask for a fair hearing.
If DHS plans to reduce or end your Medical Assistance, the advance notice gives a date 10 calendar days after the notice was mailed.
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 (Medical Assistance (Medicaid); HealthChoices managed care) denials in Pennsylvania
- Medicaid agency
Pennsylvania Department of Human Services (DHS) and County Assistance Offices
- Who holds the hearing
DHS Bureau of Hearings and Appeals (BHA)
- Hearing deadline
30 days
The date of the written notice of the decision or action
- If you are late
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.
- How to ask for a hearing
- Mail: Send a written appeal to the office that sent you the notice (usually your County Assistance Office). Your notice explains where and how to appeal.
- Form: Use the appeal form that comes with your notice.
- Phone: An oral appeal must be put in writing and signed within 3 working days; the County Assistance Office will help you.
- 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.
Law: 55 Pa. Code 133.4(b), 275.4(a)(3); 55 Pa. Code 275.3, 275.4
- When the hearing is held
Hearings are set as soon as possible with at least 10 days' notice. A final decision is due within 90 days of the appeal for Medical Assistance; if it is late, you may be able to get interim assistance.
Law: 55 Pa. Code 275.4(c)-(e); 55 Pa. Code 275.3, 275.4
- Faster (expedited) hearing
In HealthChoices, if your doctor or dentist says waiting could harm your health, call DHS at 1-800-798-2339, email RA-PWCGFHteam@pa.gov or fax your request to 717-772-6328; your doctor must fax a signed letter to 717-772-6328 or testify. DHS holds a phone hearing and decides within 3 business days.
Law: 55 Pa. Code 275.3, 275.4
Medicaid health plan (managed care) in Pennsylvania
- Appeal to the plan first
File a Grievance with your HealthChoices plan within 60 days of the notice that denied, reduced or changed a service. The plan decides within 30 days; an expedited Grievance is decided within 72 hours of your request (or 48 hours after your doctor's letter, whichever is sooner). If you disagree, ask DHS for a Fair Hearing in writing, postmarked within 120 days of the date on the Grievance decision notice: DHS, OMAP - HealthChoices Program, Complaint, Grievance and Fair Hearings, P.O. Box 2675, Harrisburg, PA 17105-2675; fax 717-772-6328; email RA-PWCGFHteam@pa.gov. To keep services you already get: file the Grievance within 10 days of the date on the plan's first notice; after a Grievance decision, ask for the external review or Fair Hearing (hand-delivered or postmarked) within 15 days of the date on that decision notice.
- Then a state hearing
120 days
The date on the notice of the plan's Grievance (or First Level Complaint) decision
- If the plan is late
If the plan does not decide your Complaint or Grievance in time, you can ask for a Fair Hearing within 120 days from the date on the notice telling you the plan failed to decide.
- Optional outside medical review
After a Grievance decision you can also ask the plan, by phone or letter, for an external Grievance review within 15 days of getting the decision (2 business days for an expedited Grievance decision). The plan sends it to the Pennsylvania Insurance Department, which arranges the independent review; a decision comes within 60 days. You can ask for an external review, a Fair Hearing, or both.
Law: DHS HealthChoices Physical Health notice templates GG(14), GG(15), GG(17) (agreement effective 1/1/2024); 40 P.S. 991.2161, 991.2162
Write my appeal: free letters
Sources
The official sources for Pennsylvania are listed on the Pennsylvania page.