Questions & answers · Health insurance
How long do I have to ask for a Medicaid fair hearing?
Health insuranceAppealChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: 42 CFR 431.221 (eCFR (current as of 2026-11-02)) · § 431.221(d) View original ↗
In short
- Ask for a Medicaid fair hearing by the date on your notice.
- For most decisions, the limit is 90 days or less from the mail date.
- In a Medicaid health plan, you get 90 to 120 days after the plan's appeal decision.
What this means
For most Medicaid decisions, the agency must give you a reasonable time to ask for a fair hearing. That time can't be more than 90 days from the date the notice is mailed [1]. Your state may give you fewer days, so check your notice. If you are in a Medicaid managed care plan (an MCO, a prepaid inpatient health plan (PIHP), or a prepaid ambulatory health plan (PAHP)) and the plan has decided your appeal, the rule is different. You must have no less than 90 and no more than 120 calendar days from the date of the plan's decision notice to ask for a state fair hearing [3]. The state usually must decide within 90 days. For plan members, the 90 days count from the date you filed your plan appeal, not counting the days you took to ask for the hearing. For everyone else, they count from the date the agency gets your hearing request [2]. The state may take longer in unusual cases, such as when you ask for a delay or there is an emergency beyond its control [2].
Where this comes from (3)
[1] 42 CFR 431.221 (eCFR (current as of 2026-11-02)) · § 431.221(d) · checked 2026-11-05
The agency must allow the applicant or beneficiary a reasonable time, not to exceed 90 days from the date that notice of action is mailed, to request a hearings.
[2] 42 CFR 431.244 (eCFR (current as of 2026-11-02)) · § 431.244(f)(1), (f)(4) · checked 2026-11-05
(1) Ordinarily, within 90 days from: (i) The date the enrollee filed an MCO, PIHP, or PAHP appeal, not including the number of days the enrollee took to subsequently file for a State fair hearing; or (ii) For all other fair hearings, the date the agency receives a request for a fair hearing … (4)(i) … except in unusual circumstances when— (A) The agency cannot reach a decision because the appellant requests a delay o…
[3] 42 CFR 438.408 (eCFR (current as of 2026-11-02)) · § 438.408(f)(2) · checked 2026-11-05
The enrollee must have no less than 90 calendar days and no more than 120 calendar days from the date of the MCO's, PIHP's, or PAHP's notice of resolution to request a State fair hearing.
How we found this
We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-05.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
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