How to Appeal a Medicaid Denial

Medicaid recipients have strong appeal rights protected by federal law, including the right to a state fair hearing and, in many cases, the right to continue receiving services during the appeal. This guide covers your federal protections and how to navigate the process.

Federal Medicaid Appeal Rights

All Medicaid recipients have these federal rights:

  1. Written notice of any denial, reduction, or termination
  2. Right to appeal within the timeframe specified (typically 30-90 days)
  3. State fair hearing if the managed care plan's appeal is denied
  4. Aid-continuing: Services continue during appeal if filed within 10 days of notice

Medicaid Managed Care Appeals

Most states use managed care organizations (MCOs):

  1. Internal MCO appeal: File with your MCO first
  2. State fair hearing: If MCO appeal denied, request a state fair hearing
  3. No cost: Medicaid appeals are always free

Key Tips

  1. File within 10 days to preserve aid-continuing rights
  2. Get free legal help: Contact your state's Legal Aid or Law Help
  3. Gather medical records and physician support letters
  4. Know your state's rules — each state has specific procedures
  5. Disability Rights organizations can help with disability-related denials

Free Legal Resources

  • Legal Services Corporation: lsc.gov
  • National Health Law Program: healthlaw.org
  • Your state's Legal Aid organization

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Frequently Asked Questions

What does aid-continuing mean for Medicaid appeals?

Aid-continuing means your Medicaid services continue while your appeal is pending. To get this protection, you usually must file your appeal within 10 days of receiving the denial notice. If you win, services continue uninterrupted. If you lose, you may have to repay the cost of services received during the appeal.

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