Will Medicaid keep paying for my care while my appeal is pending?

This card is about Medicaid managed care plans, under a federal rule (42 CFR 438.420). Your plan must keep your care going if five things are true [1]. You file your appeal on time. The appeal is about ending, pausing or lowering a service the plan already approved. An authorized provider ordered the service. The time covered by the first approval has not run out. And you ask for the care to continue in time [1]. You ask in time if you file by the later of two dates. One is 10 calendar days after the plan sent the notice. The other is the date the cut is meant to start [1].

If you ask, your benefits must continue while the appeal or state fair hearing is pending. They continue until something ends it, such as you withdrawing the appeal or hearing request [1].

One risk: if the final decision goes against you, the plan may recover the cost of the services it gave you while the appeal was pending [1]. This follows your state's usual recovery policy and the plan's contract, and it applies to services given only because of this rule [1]. The sources don't say how this works in your state.

Open GovInfo, 42 CFR § 438.420, at https://www.govinfo.gov/content/pkg/CFR-2025-title42-vol4/xml/CFR-2025-title42-vol4-sec438-420.xml and read the part quoted above. Your own plan or policy papers hold details these sources do not give: "Don't know yet" for your case.