Denied or Dropped From Medicaid? How to Appeal and Get It Back

Yes. You have the right to a "fair hearing" if your Medicaid was denied, reduced, or terminated. You generally have up to 90 days from the date on your notice to ask for one, but 90 days is the federal maximum and some states allow less, so the deadline printed on your own notice is what counts. Ask in writing, and keep proof of the date you asked.

This is the most important timing rule. Before stopping your coverage, the state must send you advance notice (generally at least 10 days). If you request a fair hearing BEFORE your coverage-end date, your coverage continues while the appeal is decided, this is called "aid paid pending." If you wait until after the end date, there is a gap. One caution: if you lose the appeal, you can be asked to repay the cost of the coverage you kept, though that is unlikely if you genuinely still qualify.

Often yes. If you lost coverage just because a renewal form or document was not returned, you usually have at least 90 days after the termination to send it in, and the state must reconsider you WITHOUT a brand-new application (a "reconsideration"). That is often faster than a formal hearing. See our guide on keeping your Medicaid at renewal for the steps. You can pursue reconsideration and a fair hearing at the same time.

Two paths, and you can use both. You can request a fair hearing to challenge the denial, and, if the denial was due to something fixable (missing proof, a form error), you can also correct it and reapply. First, read the notice for the exact reason you were denied, that determines your best move. If it was denied for missing income proof, sending that proof may resolve it quickly.

The state generally must reach a final decision within 90 days of the date you requested the hearing. You will get a chance to explain your case and submit documents, in person, by phone, or in writing depending on the state. If your coverage is continuing during the appeal, it stays on until that decision.

The notice you received, and proof that you qualify: recent pay stubs or proof of income, who is in your household, proof of residency and identity, and any specific document the state said was missing. If a doctor or hospital is involved, records that support your case help too. Organized proof is what wins these.

The appeal itself is something you can do for free, and free trained helpers can assist: navigators, legal aid, and community health workers (find help at LocalHelp.HealthCare.gov or call 2-1-1). Where CareRoute is paid is Bill Defense: if losing coverage left you with a medical bill, we review and negotiate it, and you only pay if we save you money. We do not charge you to appeal.