Questions & answers · Health insurance
My Medicaid health plan denied a service. What are the steps and deadlines?
Health insuranceAppealChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: 42 CFR 438.402 (eCFR (current as of 2026-11-02)) · § 438.402(b), (c)(2)(ii), (c)(3)(ii) View original ↗
In short
- First appeal to your Medicaid plan within 60 days.
- The plan usually must decide within 30 days, or 72 hours if fast.
- If it still says no, you get 90 to 120 days to ask for a state hearing.
What this means
First, appeal to your Medicaid managed care plan. You have 60 calendar days from the date on the denial notice. You can ask out loud or in writing [1]. The plan must decide within the time your state sets. That can be no longer than 30 calendar days from the day the plan gets your appeal, or 72 hours for a fast (expedited) appeal [2]. The plan may extend these times by up to 14 calendar days in some cases [2]. If the plan still says no, you can ask for a state fair hearing. 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. The exact number depends on your state [3].
Where this comes from (3)
[1] 42 CFR 438.402 (eCFR (current as of 2026-11-02)) · § 438.402(b), (c)(2)(ii), (c)(3)(ii) · checked 2026-11-05
an enrollee has 60 calendar days from the date on the adverse benefit determination notice in which to file a request for an appeal to the managed care plan. … (ii) Appeal. The enrollee may request an appeal either orally or in writing.
[2] 42 CFR 438.408 (eCFR (current as of 2026-11-02)) · § 438.408(b)-(c) · checked 2026-11-05
the State must establish a timeframe that is no longer than 30 calendar days from the day the MCO, PIHP, or PAHP receives the appeal. … no longer than 72 hours after the MCO, PIHP, or PAHP receives the appeal. … may extend the timeframes from paragraph (b) of this section by up to 14 calendar days
[3] 42 CFR 438.408 (eCFR (current as of 2026-11-02)) · § 438.408(c)(3), (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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