Medicaid denied my care: how do I ask for a fair hearing?
A denial letter is not the final word, and the clock on it is the part to watch. You are not alone, and you can speak for yourself at a hearing.
CheckMyDenial team, patient billing and appeals. Published October 2026. Last reviewed 2026-10-29.
Medicaid denied my care. Can I fight it?
Yes. Anyone applying for or enrolled in Medicaid who disagrees with a state decision to deny, suspend, end, or reduce their coverage or services has the right to ask for a fair hearing. You can also ask if the state did not decide within a reasonable time.
Your state has to tell you this in writing, including the steps and the number of days you have. Look for that part of your letter first. A denial can feel like a dead end, and you are not alone in this.
This page is about Medicaid only. If your denial came from Medicare, a job-based plan, or a Marketplace plan, the appeal steps and deadlines are different, so check which one sent your letter.
How do I ask for a Medicaid fair hearing?
The details change by state, so your notice is your best guide. These four steps work as a starting point.
Not legal advice: we are not lawyers, and your state's rules come first.
- Step 1: Find the date and the deadline. Read your denial notice. Write down the date on it, the date the decision takes effect (often called the date of action), and how many days you have to ask for a hearing.
- Step 2: Find where to send the request. The notice should say how to ask. In every state you can ask by mail or in person. Some states also take phone or online requests. In many states a separate state agency, not the Medicaid agency, runs the hearings, so you may need to send your request there.
- Step 3: Send a short written request. Say you disagree with the decision and want a fair hearing. Include your name, case or member number, and the date of the notice. Keep a copy, and keep proof of when and how you sent it.
- Step 4: Ask for your case file and get ready. You can look at your case file and the documents the state will use, both before and during the hearing. Gather your letter, doctor notes, and any bills. You may bring a lawyer, family member, friend, or witnesses, or speak for yourself.
How long do I have to ask for a fair hearing?
It depends on your state. In some states you must ask within 30 days of the date on the notice. Other states give up to 90 days. Do not wait to find out which one you have: look at the date on your letter today.
If you get your care through a Medicaid managed care plan, you usually appeal to the plan first, then ask the state for a hearing. Federal rules let states set that second window anywhere from 90 to 120 days after the plan's answer to your appeal. Your notice will say which applies to you.
Can I keep my Medicaid benefits while I appeal?
Sometimes. If you already have Medicaid and you ask for a fair hearing before the date the decision takes effect, the state must keep your benefits going until the final hearing decision. That date can be as little as 10 days after the date on your notice, so ask early.
Some states may also restore benefits if you ask within 10 days after that date. One catch: if you lose, some states can ask you to pay back the cost of services you got while you waited. Ask your state agency how this works where you live.
How long does a fair hearing take, and what if it is urgent?
In general, the state must decide and carry out the result within 90 days of getting your request. As of March 2024, some states had temporary permission to take longer while returning to normal operations after the COVID-19 emergency. Ask your state if that still applies.
If you have an urgent health need that could cause serious harm if it is not treated soon, you have the right to ask for an expedited (faster) hearing. Your decision notice must explain how.
What happens if I win or lose the hearing?
The state must send you the decision in writing. If it is in your favor, Medicaid must fix the problem right away and apply the result back to the date of the wrong decision. If you lose, the written decision must tell you about any further appeal rights in your state, such as asking a court to review it.
You are also entitled to free interpreters and translated materials if you do not speak English well, and free aids and services if you have a disability.
I have a photo of my denial letter. Can someone tell me where it breaks?
Yes. Text a photo of your denial letter to (213) 606-6303. We read it and reply with where it breaks. It is free, with no account and no form.
Your checklist
- Check that my denial letter came from Medicaid, not Medicare or another plan
- Find the date on my denial notice
- Write down the deadline to ask for a hearing and the date the decision takes effect
- If I am in a Medicaid managed care plan, check whether I must appeal to the plan first
- Ask for the hearing in writing before the date of action if I want to keep my benefits
- Keep a copy of my request and proof of how and when I sent it
- Ask to see my case file, and gather my letter, doctor notes, and bills
- Ask for a faster (expedited) hearing if waiting could harm my health
- Text a photo of my denial letter to (213) 606-6303
A letter you can copy
[Date] [State Medicaid agency or hearings office name] [Address from my denial notice] Re: Request for a fair hearing Name: [Your full name] Case or member number: [Number] Date of the notice: [Date on the denial letter] I disagree with the decision described in the notice above, which [denied / reduced / suspended / ended] my [coverage or service: for example, the care or claim named in the notice]. I am asking for a fair hearing. [If your benefits are currently active: I also ask that my benefits continue until the hearing decision is issued.] [If waiting could harm your health: I am asking for an expedited hearing because [short reason].] Please send me a copy of my case file and the documents the state will use at the hearing, and the date, time, and place of the hearing. Contact: [Phone] / [Address] / [Email] Sincerely, [Your name]
Which rules apply to you?
The steps and deadlines on this page can differ by the kind of plan you have. Your own denial letter always comes first.
- Coverage through a job:ask your HR team whether the plan is “self-funded” or “fully insured.” It can change who you can ask for help. Most private-sector job plans fall under a federal law called ERISA, and the U.S. Department of Labor’s EBSA takes health plan questions at Ask EBSA or 1-866-444-3272.
- Marketplace plan: follow the appeal steps at HealthCare.gov.
- Medicare or Medicaid: each has its own appeal process, listed on your notice.
- Dental-only plan: your plan contract sets the appeal rights, so read it and your letter.
Related answers
Sources: Medicaid.gov: Understanding Medicaid Fair Hearings (CMS factsheet, March 2024). KFF: CMS's 2020 Final Medicaid Managed Care Rule, a summary of major changes. Medicaid.gov: Where can people get help with Medicaid and CHIP (state contacts). More in the full appeal guide.
Start here
Have the denial letter? Send it to us.
Text a photo of your denial letter to (213) 606-6303. We read it and reply with where it breaks. Free, no account, no form.
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Free tools for the next step
Keep your appeal papers in one place. Take a photo of your denial letter, EOBs and insurance cards with GetPreCare, so they are on your phone when the insurer or the office asks. Free. Open GetPreCare. Helping a parent or partner? Set it up for them.