Federal agency ยท Centers for Medicare & Medicaid Services, Medicaid.gov
Medicaid fair hearings: federal explainer
A federal fact sheet on the right to a Medicaid fair hearing when a state denies, reduces or ends your Medicaid benefits, with hearing rights, deadlines that vary by state, and how benefits can continue.
Know before you go
Anyone applying for or enrolled in Medicaid can ask for a fair hearing about a denied, reduced, suspended or ended benefit. The fact sheet is mainly about eligibility decisions, and each state sets its own steps and deadline: it says some states allow 30 days from the date on the notice and others up to 90. It is general federal information, so your state notice controls. If you already have Medicaid and ask before the date the action takes effect, the state must keep your benefits going until the decision.
- Cost
- Not stated. The fact sheet lists no fee.
- Where
- Nationwide
- How to start
- Find the fair hearing instructions on the notice from your state Medicaid agency, and ask for the hearing before the deadline. Ask for an expedited (faster) hearing if waiting could seriously harm your health.
- Have ready
- Your state notice of the decision; Your Medicaid case number; Records or a letter from your doctor
Where this comes from
- Provider
- Centers for Medicare & Medicaid Services, Medicaid.gov
- Source we read
- https://www.medicaid.gov/resources-for-states/downloads/mdcid-fair-hrings-prtnr-rsurce.pdf
- Date we read it
- . This is not a fresh check.
- Date the provider printed
- Not displayed
- What we checked
- We read the provider's public page. We have not verified availability, eligibility or outcomes for any individual.
Other starting points
- Program or service
Beneficiary and Family Centered Care Quality Improvement Organizations: find yours
The Medicare contractors that handle fast appeals when hospital or other care is ending too soon, and complaints about the quality of care. Each state is assigned to one of two organizations.
From Centers for Medicare & Medicaid Services
- Program or service
California Department of Managed Health Care: Independent Medical Review
California's regulator for managed care plans reviews denials of medical services, emergency payment and experimental treatment through Independent Medical Review. One form starts either a review or a consumer complaint.
From California Department of Managed Health Care
- Program or service
Center for Medicare Advocacy self-help materials
Downloadable self-help toolkits for Medicare denials involving home health care, outpatient therapy and skilled nursing facility care, from a nonprofit law organization. The page describes materials, not a helpline.
From Center for Medicare Advocacy