Medicaid Denied? How to Request a Fair Hearing

Why was your Medicaid application denied?

Before you appeal, understand why you were denied. Your denial notice should explain the reason. Common reasons include:

• Your income is too high for your state's Medicaid program
• You did not provide required documents or information
• You do not meet your state's eligibility rules
• There was an error in processing your application

Read your denial notice carefully. It will tell you what the agency thinks happened and what you can do next.

Check if you can appeal

You have the right to appeal if you believe the decision was wrong. You can appeal for many reasons:

• The agency made a mistake about your income or family size
• You have new information that changes your eligibility
• The agency did not follow the rules correctly
• You did not understand what documents you needed to send

Most states allow you to appeal any Medicaid decision, including denials.

Request a fair hearing

A fair hearing is your chance to present your case to an independent reviewer. Here's how to request one:

Step 1: Find your state Medicaid agency contact information

Your denial notice should list how to appeal. You can also contact your state Medicaid office directly. Go to our state pages to find your state's Medicaid contact information.

Step 2: File your appeal within the deadline

You usually have [VERIFY: standard appeal deadline days] days from the date on your denial notice to request a fair hearing. Send your appeal in writing to your state Medicaid agency. Include:

• Your name and case number
• The reason you disagree with the decision
• Your contact information (phone number and address)

You can appeal by mail, email, or phone—your denial notice will say which methods your state accepts.

Step 3: Gather your evidence

Collect documents that support your case. This might include:

• Pay stubs or tax returns showing your income
• Documents proving your identity or citizenship
• Medical records if your appeal is about a disability decision
• A letter from your employer confirming your job or income
• Proof that you submitted required documents on time

Step 4: Prepare for the hearing

The hearing may be in person, by phone, or by video, depending on your state. You will have a chance to explain your case and answer questions. You can:

• Bring documents and evidence
• Bring a friend, family member, or advocate to help you
• Ask questions about the decision
• Present new information

What happens after the hearing

After the hearing, an independent decision maker will review everything and make a new decision. They will send you a written decision in the mail. If you win the appeal, your coverage may start right away or on a date set by the state.

If you lose, you may be able to appeal again or take other steps. Ask your state Medicaid agency what your next options are.

Get help with your appeal

You do not have to do this alone. Many states have free legal aid programs that help people appeal Medicaid denials. Ask your state Medicaid agency if they can refer you to free legal help.

Applying for Medicaid and appealing a denial are free. Only the state agency can decide if you qualify.