Medicaid Fair Hearings By State - Deadlines, Contact Info, Forms

If your Medicaid claim is denied, you have the right to appeal. That appeal — called a state fair hearing — is guaranteed by federal law for every Medicaid member in the country.

But the deadline to request one varies significantly by state. In 15 states, you have just 30 days from the date of the denial notice. In others, you have up to 120 days. Miss the deadline, and you generally lose the right to appeal that decision.

This page lists the filing deadline, contact information, and official forms for every state and territory. Find your state in the table below.

Click to expand

1. What is a Medicaid fair hearing?

A Medicaid fair hearing is a formal appeal process. If your Medicaid managed care plan denies, reduces, or terminates a service, you can request a hearing where an impartial state reviewer looks at the decision.

The hearing is run by your state — not by the managed care plan that denied you. That separation matters. The reviewer has not seen your case before and has no stake in the plan’s original decision.

Federal law — specifically 42 CFR § 431.220 — guarantees this right to all Medicaid members. It applies whether you are in a managed care plan or fee-for-service Medicaid.

Who can request a fair hearing?

•     Any Medicaid member whose claim has been denied,reduced, or terminated

•     Members who believe a service was wrongly classified orbilled

•     Members whose coverage has been reduced or ended andwho believe the decision was wrong

•     An authorized representative filing on behalf of amember

One critical exception: the 10-day rule

If you are at risk of losing your Medicaid coverage — not justa single claim, but your eligibility itself — most states require you to file within 10 days of the determination notice to keep your coverage active while the appeal is pending.

This is called “continuation of benefits.” If you miss the 10-day window, your coverage may be terminated before the hearing decision comes back. Check your determination notice carefully for this distinction.

2. How the process works

The fair hearing process has two main steps. Both have deadlines that vary by state.

Step 1: Internal appeal

Before you can request a state fair hearing, most states require you to go through the managed care plan’s own internal appeal process first. You file with the plan, they assign a new reviewer, and they issue a new decision. Timelines for this step vary by state — typically 10 to 90 days.

If the plan upholds the denial, you can then escalate to the state.

Step 2: State fair hearing

You submit a request to the state agency listed in the table below. The state assigns an impartial hearing officer. You present your case —in person, by phone, or in writing depending on the state. The hearing officer issues a written decision, typically within 90 days.

The decision is binding on the managed care plan. If thehearing officer finds in your favor, the plan must provide the service or coverage.

What to bring or submit

•     Your denial notice — the written decision from the plan

•     Your Medicaid member ID and plan information

•     A clear written statement of what you are appealing and why

•     Any supporting documentation — medical records, letters from your doctor, prior authorization paperwork

•     The completed request form for your state (linked in the table below where available)

3. Deadline and contact information by state

The table below shows the filing deadline, phone number, fax, email, mailing address, and official form for each state. All deadlines run from the date of the written decision notice from your managed care plan.

Deadlines and contact information change periodically. Always verify current information with your state agency before filing.

Sources:

CMS: Medicaid Fair Hearings — 42 CFR § 431.220

CMS: Medicaid Fair Hearings Partner Resource

Related: Got a Medicare or Medicaid Bill That Looks Wrong? Here's What You Can Do