How to appeal a Medicaid denial

You have the right to appeal a Medicaid decision. Your notice must explain the reason and how to appeal. You can usually request a fair hearing within 90 days, and acting faster may help you keep benefits during your appeal.

Common reasons for denial

• Missing documents or a missed deadline
• Income or assets over the limit
• A household size error
• Citizenship or immigration questions
• A service not found medically necessary

How to appeal

1. Read the notice and note the deadline.
2. Call and ask what's missing. It may be a quick fix.
3. Request a hearing in writing, or as your notice directs.
4. Gather proof, such as pay stubs or a letter from your doctor.
5. Attend the hearing, and bring a helper if you want.

Plan denials are different

If a managed care plan denies a service, you usually must appeal with the plan first, then can ask for a state fair hearing. Ask for an urgent review if waiting could harm your health.

Keeping benefits during an appeal

If your coverage is being cut or ended, you may be able to keep it while you appeal if you ask quickly, often within about 10 days of the notice. Check your notice, since you may have to repay if you lose.

Free help

Legal aid offices can often help. Find yours through LawHelp.org or by dialing 211. You can also reapply at any time if things change.