Questions & answers · Health insurance
My Medicaid plan denied a service. How do I appeal and by when?
Health insuranceAppealChecked Nov 6, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: GovInfo · 42 CFR § 438.402 «General requirements (grievance and appeal system)» · paragraphs (c)(2), (c)(3) View original ↗
In short
- You have 60 days from the denial notice to appeal to your Medicaid plan.
- The plan must decide within 30 days, or 72 hours if it is urgent.
- After that you can ask for a state fair hearing, within 90 to 120 days of the plan's answer.
What this means
This card is about Medicaid managed care plans. The federal rules are 42 CFR 438.402, 438.408 and 431.244. You have 60 calendar days from the date on the denial notice to file an appeal with your plan. You may ask by phone or in writing [1]. The state must set a time limit for the plan to decide. It can be no longer than 30 calendar days from the day the plan gets the appeal [2]. For an urgent appeal, it can be no longer than 72 hours [2]. The plan may extend these times by up to 14 calendar days in some cases [2].
If the plan's answer is still no, you have at least 90 and no more than 120 calendar days from the date of the plan's notice to ask for a state fair hearing [2]. The state ordinarily decides a hearing within 90 days of the date you filed the plan appeal. That does not count the days you took to ask for the hearing [3]. For an urgent service denial not resolved in time, the state must act as fast as your health needs, no later than 3 working days after it gets the case file [3].
If your Medicaid is not through a managed care plan, the state must allow a reasonable time, not more than 90 days from the date the notice of action is mailed, to ask for a hearing [4].
Your next step
File your appeal with the plan within 60 calendar days of the date on the denial notice [1]. The deadlines these sources give are 60 days to appeal to the plan and 90 to 120 days from the plan's notice to ask for a state fair hearing [1] [2].
Check it yourself
Open GovInfo, 42 CFR § 438.402, at https://www.govinfo.gov/content/pkg/CFR-2025-title42-vol4/xml/CFR-2025-title42-vol4-sec438-402.xml and read the part quoted above. Sources 2–4 list more pages to open. Your own plan or policy papers hold details these sources do not give: "Don't know yet" for your case.
Where this comes from (4)
[1] GovInfo · 42 CFR § 438.402 «General requirements (grievance and appeal system)» · paragraphs (c)(2), (c)(3) · checked 2026-11-06
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 … The enrollee may request an appeal either orally or in writing
[2] GovInfo · 42 CFR § 438.408 «Resolution and notification: grievances and appeals» · paragraphs (b), (c), (f) · checked 2026-11-06
timeframe that is no longer than 30 calendar days from the day the MCO, PIHP, or PAHP receives the appeal … For expedited resolution of an appeal and notice to affected parties, the State must establish a timeframe that is 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 … 90 calendar days and no more than…
[3] GovInfo · 42 CFR § 431.244 «Hearing decisions» · paragraph (f) · checked 2026-11-06
Ordinarily, within 90 days from: ( i ) The date the enrollee filed an MCO, PIHP, or PAHP appeal, not including the number of days the enrollee took to subsequently file for a State fair hearing … no later than 3 working days after the agency receives, from the MCO, PIHP, or PAHP, the case file and information
[4] GovInfo · 42 CFR § 431.221 «Request for hearing» · paragraph (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 4 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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