Medicaid denied my claim saying I have other insurance, but I don't. What can I do?

Health insuranceDeniedChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: GovInfo · 42 CFR 433.139 Payment of claims · § 433.139(b)(1) View original ↗

In short

The agency must turn down a claim if other insurance is probably there.
Some children's care is paid first.
You can ask for a hearing in 90 days or less.

What this means

If the state Medicaid agency finds that other insurance probably exists when the claim is filed, it must reject the claim. It sends the claim back to the provider to find out how much the other insurer owes [1]. When that amount is known, the agency pays only the part that its own rate is above it [1].

There are exceptions. For some children's preventive care, the agency pays the full allowed amount first. Then it asks the other party to repay it [1]. The sources do not say how to fix a wrong record. If you disagree with a decision, you may ask for a hearing. The time is set in your notice, and it can't be more than 90 days from the mailing date [2].

Your next step

Ask for a hearing within the time on your notice, which under the federal rule can't be more than 90 days from the date the notice was mailed [2]. The sources do not say how to correct the other-insurance record.

Check it yourself

Your Medicaid denial notice and your state Medicaid office tell you which rules apply in your state. The sources here do not cover managed care plans for this question — "Don't know yet".

Where this comes from (2)

[1] GovInfo · 42 CFR 433.139 Payment of claims · § 433.139(b)(1) · checked 2026-11-06
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 … When the amount of liability is determined, the agency must then pay the claim to the extent that payment allowed under the agency's payment schedule exceeds the amount of the third party's payment …
[2] GovInfo · 42 CFR 431.221 Request for hearing · § 431.221(d) · checked 2026-11-06
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 2026-11-06.

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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