Questions & answers · Health insurance
My Medicaid health plan hasn't decided my prior authorization request. How long can it take?
Health insuranceDeniedChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: 42 CFR 438.210(d)(1)–(2) «Coverage and authorization of services — Timeframe for decisions» · GovInfo, CFR 2024 edition, Title 42 Vol. 4 View original ↗
In short
- From 2026, a Medicaid plan has up to 7 days for most prior approval requests.
- Urgent requests must be decided within 72 hours.
- Ask your provider to ask for the fast track if waiting could hurt you.
What this means
For Medicaid managed care plans (MCOs, PIHPs and PAHPs), the federal rule sets the outer limits for prior authorization decisions [1]: • Standard requests: as fast as your condition requires, and within state time frames that may not exceed 7 calendar days after the plan receives the request, for rating periods starting on or after January 1, 2026 (14 calendar days before that). The plan can extend by up to 14 more calendar days if you or your provider ask, or if the plan justifies the need for more information and how the extension helps you. • Expedited requests: when your provider says, or the plan finds, that the standard time could seriously jeopardize your life, health or ability to regain maximum function, the plan must decide no later than 72 hours after it receives the request. That can also be extended by up to 14 calendar days in the same cases.
Your state can set shorter limits; these are the federal maximums.
Your next step
if the time has passed or the plan says no, use the Medicaid appeal and fair hearing steps (see the Medicaid appeal answers). Ask your provider to request the expedited track if waiting could harm your health.
Where this comes from (1)
[1] 42 CFR 438.210(d)(1)–(2) «Coverage and authorization of services — Timeframe for decisions» · GovInfo, CFR 2024 edition, Title 42 Vol. 4 · checked 2026-11-05
(1) Standard authorization decisions. (i) For standard authorization decisions, provide notice as expeditiously as the enrollee's condition requires and: (A) For rating periods that start before January 1, 2026, within state established time frames that may not exceed 14 calendar days after receiving the request for service. (B) For rating periods that start on or after January 1, 2026, within state established time …
How we found this
We matched your question to 1 official source, 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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