Your coverage
Medicaid and children's coverage
Medicaid, Medicaid managed care plans and the Children's Health Insurance Program.
Do this today
- Find the kind of plan you have Pick the closest match below. Each page has the appeal steps, deadlines and free help for it.
- Read: Children's Health Insurance Program appeals 4 minute read. Your child's separate Children's Health Insurance Program plan denied something. Ask for an independent review, not a Medicaid fair hearing. Here is what the federal rules do and do not promise.
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Put this step on My Plan
So you can come back to it, and keep your dates and calls in one place.
In brief
- A separate Children's Health Insurance Program (CHIP) uses a state review and an independent external review, not the Medicaid fair hearing.
- Federal rules require external review to finish within 90 calendar days, or 72 hours if fast. They do not set one request deadline for every state, so read your notice.
- Federal CHIP rules do not require a disputed service to continue during review. Continued enrollment is required only in set situations.
- Check the date on your notice, which controls.
Read the full guide: Children's Health Insurance Program appeals
Coverage types in this group
Each page has the appeal steps, deadlines and free help for that coverage.
- Medicaid (fee-for-service)
Medicaid paid directly by your state, not through a managed care plan. Your appeal is a state fair hearing. The deadline is on your notice and varies by state, up to 90 days from the date the notice was mailed.
- Medicaid managed care plan
Medicaid delivered through a private health plan. Appeal to the plan first, within 60 days of the date on its notice. After the plan's decision you have 90 to 120 days to ask your state for a fair hearing.
- Children's Health Insurance Program
Low-cost coverage for children run by your state. A separate program uses an independent external review, not a Medicaid fair hearing. For a managed care plan, the plan appeal comes first, within 60 days.
More guides, tools and letters
More guides, tools, letters 12
Guides
- Children's Health Insurance Program appeals
Your child's separate Children's Health Insurance Program plan denied something. Ask for an independent review, not a Medicaid fair hearing. Here is what the federal rules do and do not promise.
- Medicaid appeals and fair hearings
How to challenge a Medicaid denial, cut or ending of benefits in a state fair hearing. Learn what notice you must get, how to keep benefits going, and why your state's deadline matters most.
- Medicaid managed care: the plan appeal comes first
If a Medicaid health plan denies or cuts a service, you appeal to the plan within 60 days. Only after that can you ask the state for a fair hearing. Here is the order and how to keep benefits going.
- What a Medicaid fair hearing is like
A calm walk through a Medicaid fair hearing. Learn how to prepare, what happens on the day, and what the agency's lawyer does. Know the rights federal rules give you.
Tools
- Tool
Medicaid hearing planner
Work out the order of steps, the deadlines that apply, the earlier deadline to keep your services going, and how to prepare for a fair hearing.
Letters and scripts
- Letter or script
Appeal my Medicaid plan's cut and keep my services going
Ask your Medicaid health plan to appeal a cut or ending of a service you already get, and to keep the service going while it decides. Ask within 10 calendar days of the notice, or before the change takes effect if that is later.
- Letter or script
Medicaid fair hearing request
Ask your state for a fair hearing when Medicaid denied, reduced or stopped a service. If you have a Medicaid plan, you appeal to the plan first.
- Letter or script
Phone script: appeal to your Medicaid plan and keep services going
What to say when you phone your Medicaid health plan to appeal a cut or ending of services and keep them going during the appeal, what to ask for, what to do if told the provider must ask, and what to write down.
Programs and services
- Program or service
Disability Rights Florida guide to Medicaid fair hearings
A step-by-step explanation of how to challenge a denial or reduction of Medicaid services in Florida, from notice to petition to hearing. For people with disabilities. Florida only.
From Disability Rights Florida
- Program or service
Health Consumer Alliance (California)
A statewide partnership of legal aid organizations offering free help by phone or in person to Californians with Medi-Cal, Covered California or private coverage, including disputing denials and billing problems.
From Health Consumer Alliance
- Program or service
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.
From Centers for Medicare & Medicaid Services, Medicaid.gov
- Program or service
National Disability Rights Network: find your state agency
A directory of the federally mandated Protection and Advocacy agencies, one in every state and territory, that provide legal advocacy for people with disabilities, including difficulty getting disability services.
From National Disability Rights Network
Questions to keep handy
- What exactly was denied, and under which part of the plan?
- What is my deadline, and what is it counted from?
- Where and how do I send my request, and how will I prove it arrived?
- Who decides, and can I ask for a faster decision?
Not what you need? Find a person who can help, or search the whole site.