How Medicaid Appeals Work Step by Step

Medicaid Appeal Overview

Medicaid appeals follow federal requirements but are implemented differently in each state. The fundamental right to a fair hearing is guaranteed by federal law.

Appeal Steps

1. Managed care internal appeal — if you have Medicaid managed care, file with your plan first (30-60 days)
2. Request aid continuing — file within 10 days of denial to maintain services during appeal
3. State fair hearing — your right under federal Medicaid law, separate from plan appeals
4. Administrative review — some states offer additional review levels

Aid Continuing

This is your most important right. If you appeal within 10 days of the denial notice, your current services must continue while the appeal is pending. Key points:

• Services continue at the same level
• File within 10 days — this deadline is strict
• If you lose, you may need to repay for services received
• If you win, services continue uninterrupted

State Fair Hearing

Every Medicaid beneficiary has the right to a state fair hearing:

• Independent from the insurance plan
• Heard by a state hearing officer
• You can present evidence and witnesses
• Decision is binding
• Free legal assistance available through Legal Aid

Tips

• Contact your state's Legal Aid organization — they handle Medicaid appeals for free
• Medicaid advocacy organizations in your state know the specific rules
• Always request aid continuing immediately — don't wait for the full appeal