My Medicaid application was denied. How long should a decision take, and how do I appeal?

Health insuranceDeniedChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: eCFR · 42 CFR 435.912 · § 435.912(c)(3) View original ↗

In short

Most Medicaid applications must be decided within 45 days.
If you were denied, you can ask for a fair hearing.
You may also be able to buy a Marketplace plan now.

What this means

Federal rules set a time limit for a Medicaid decision. It is 90 days if you applied because of a disability, and 45 days for everyone else [1]. If you were denied, the state must let you ask for a fair hearing. The time to ask is set by the state but cannot be more than 90 days from the date the notice was mailed [2]. The state usually decides within 90 days after it gets your hearing request [3].

HealthCare.gov says to apply even if you do not think your income qualifies, especially if you have children, are pregnant, or have a disability. Medicaid may also help pay for care from the last 3 months before you applied [4]. In some states, CHIP covers children in families that earn too much for Medicaid [4].

If Medicaid or CHIP says no, you may qualify for a Marketplace Special Enrollment Period. HealthCare.gov lists cases like a change in income or a child aging out of CHIP [5].

Your next step

Read the denial notice for the reason and your state's hearing deadline. If the reason is wrong (for example income or household size), request a fair hearing and send proof. At the same time, check Marketplace options.

Deadline: no more than 90 days from the date the notice was mailed.

Check it yourself

The notice shows the reason and your state's own deadline. Your state may use a shorter hearing deadline than 90 days — "Don't know yet" for your state. Whether CHIP covers your child depends on your state's income limit — "Don't know yet".

Where this comes from (5)

[1] eCFR · 42 CFR 435.912 · § 435.912(c)(3) · checked 2026-11-06
the determination of eligibility for any applicant may not exceed— … 90 days for applicants who apply for Medicaid on the basis of disability; and … 45 days for all other applicants.
[2] eCFR · 42 CFR 431.221 · § 431.221(d) · checked 2026-11-06
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.
[3] eCFR · 42 CFR 431.244 · § 431.244(f)(1)(ii) · checked 2026-11-06
The agency must take final administrative action as follows: … Ordinarily, within 90 days from: … For all other fair hearings, the date the agency receives a request for a fair hearing in accordance with § 431.221(a)(1) .
[4] HealthCare.gov · Medicaid & CHIP coverage · page text · checked 2026-11-06
Medicaid may be able to help you pay for medical care from the last 3 months, even if you weren’t enrolled in Medicaid at the time you got medical care. Payment depends on your family’s income and medical expenses at the time. … Even if you don't think you'll qualify for Medicaid based on your income, you should apply. You might qualify for your state's program, especially if you have children, are pregnant, or have …
[5] HealthCare.gov · Special Enrollment Period · checked 2026-11-06
You may qualify if you lose or were denied Medicaid or CHIP coverage because: You're no longer eligible, like if you had a change in household income that makes you ineligible for Medicaid. Your child ages out of CHIP.

How we found this

We matched your question to 5 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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