Questions & answers · Health insurance
Medicaid denied my claim saying I have other insurance, but I don't. What can I do?
Health insuranceDeniedChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: eCFR · 42 CFR 433.139 · § 433.139(b)(1) View original ↗
In short
- Medicaid pays after any other insurance. If its records show other coverage, it sends the claim back.
- Tell your state Medicaid office the other coverage ended. Send proof.
- If you got a notice, you can ask for a fair hearing. Your state gives up to 90 days.
What this means
Under federal rules, if the state Medicaid agency has found that another insurer is probably liable when a claim comes in, it must reject the claim and send it back to the provider to find out how much the other insurer owes [1]. So if your Medicaid file still lists coverage you no longer have, claims can bounce even though you have no other insurance.
The fix usually starts with your records. Tell your state Medicaid agency that you have no other coverage, and send proof such as a letter showing the old plan's end date. Then ask the provider to send the claim again.
If the state sent you a written notice of action, you have the right to ask for a fair hearing. The state must give you a reasonable time to ask, but not more than 90 days from the date the notice was mailed [2]. You can also ask for an expedited (fast) fair hearing [2].
Your next step
Call your state Medicaid agency or plan and say "I have no other insurance." Send proof that the old coverage ended, then ask the provider to resubmit. If you have a notice of action, ask for a fair hearing by the date on it.
Deadline: your state's deadline, never more than 90 days from the date the notice was mailed.
Check it yourself
Your notice shows your state's exact hearing deadline. The sources do not say how each state updates "other insurance" records or whether a claim sent back to a provider creates a notice to you — "Don't know yet"; ask your state Medicaid agency.
Where this comes from (2)
[1] eCFR · 42 CFR 433.139 · § 433.139(b)(1) · checked 2026-11-05
If the agency has established the probable existence of third party liability at the time the claim is filed, the agency must reject the claim and return it to the provider for a determination of the amount of liability.
[2] eCFR · 42 CFR 431.221 · § 431.221(a)(1)(ii), (d) · checked 2026-11-05
Include in a hearing request submitted under paragraph (a)(1)(i) of this section, a request for an expedited fair hearing. … 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.
How we found this
We matched your question to 2 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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