How to appeal a Medicaid or CHIP denial

For a Medicaid plan, appeal within 60 days of the date on the notice, then you can ask for a state fair hearing. To keep a current service going, ask within 10 days, and check your notice because states set some of these dates.

Checked 27 September 2026 against ecfr.gov, medicaid.gov

Who decides

Medicaid appeals are run by your state, and details vary by state. You have the right to a fair hearing.

Steps

If you are in a Medicaid managed care plan, appeal to the plan first within 60 days of the date on the notice. The plan decides within 30 days, or 72 hours if urgent.
If the plan still says no, ask for a state fair hearing. States give between 90 and 120 days from the plan's decision.
If you are not in a managed care plan, ask the state for a fair hearing directly. States allow up to 90 days from the date the notice was mailed, and some allow less, so check your notice.
To keep a current service going during the appeal, ask within 10 days of the notice, or before the change takes effect, whichever is later.

Deadlines

Step	File within	Decision due
Managed care plan appeal	60 days from the date on the notice	30 days, or 72 hours if urgent
State fair hearing after a plan appeal	90 to 120 days from the plan's decision, set by your state
State fair hearing without a plan	up to 90 days from the date the notice was mailed, set by your state
Keep services during the appeal	10 days from the notice, or before the change takes effect, whichever is later

Dates are a guide. Count from the date on your notice, or the day you received it where the rule says so, and use any date printed on your notice if it differs. File early and keep proof of when you sent it.

If it is urgent

If waiting could seriously harm your health, ask for an expedited (fast) appeal and have your doctor say it is urgent. For private plans you can ask for an urgent external review at the same time.

Urgent appeals are decided within 72 hours.

Where to get free help

Your state Medicaid agency, listed at https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip
Free legal aid near you: https://www.lawhelp.org/

Free help in your state

What to send with your appeal

A copy of the denial notice or Explanation of Benefits.
A letter from your doctor explaining why the care is needed (a letter of medical necessity).
Relevant medical records, test results and notes on treatments already tried.
The pages of your plan documents that support coverage.
Notes of phone calls: date, time, who you spoke to and what they said.
Keep copies of everything, send it in a way you can track, and ask the plan to confirm it arrived.

Draft an appeal letter for the reason on your notice: not medically necessary, not an emergency, experimental, out of network, no prior authorization, a coding error or another reason.

Quick answers

How long do I have to appeal?: For a Medicaid plan, appeal within 60 days of the date on the notice, then you can ask for a state fair hearing. To keep a current service going, ask within 10 days, and check your notice because states set some of these dates.
Who decides my appeal?: Medicaid appeals are run by your state, and details vary by state. You have the right to a fair hearing.
What if my case is urgent?: If waiting could seriously harm your health, ask for an expedited (fast) appeal and have your doctor say it is urgent. For private plans you can ask for an urgent external review at the same time. Urgent appeals are decided within 72 hours.

General information, not legal or medical advice. Rules differ by plan and state, so check the dates and instructions on your own denial notice, and talk to your doctor about the medical side. Free help is available from your state and the contacts listed.

Sources

Ask Appeal My Claim yourself

Enter the date on your denial notice and get an approximate file-by date for each step. Open Appeal My Claim, free, no sign-up.

In Claude or any app that takes MCP connectors, add https://goodturn-mcp.pages.dev/appealmyclaim/mcp and ask: “How long do I have to appeal a medicaid and chip denial?”