I Got Denied. Now What?

What Happens After You Submit a Medicaid Application?

Once your Medicaid application is submitted, your state’s Medicaid agency must review it and issue a decision—usually within 45 days (or 90 days if your application is based on disability). The decision arrives in writing as either:

• Approval Notice – confirming you meet eligibility requirements.
• Denial Notice – stating you are not eligible and explaining why.

Common denial reasons include missing documents, incomplete forms, income or assets above the limit, not meeting care requirements, violations of the look-back period, or even caseworker mistakes.

Can You Appeal a Medicaid Denial?

Yes. If you disagree with a denial, you have the right to request a Medicaid Fair Hearing. This free process allows a neutral hearing officer to review your case and potentially reverse the decision. States generally have up to 90 days from your request to hold the hearing and issue a decision.

What Are the Three Types of Medicaid Denials?

• Incorrect denial due to applicant error – Mistakes on forms, missing signatures, or missing paperwork can lead to denial. Sometimes you can request a quick reversal from your caseworker instead of a formal appeal.
• Incorrect denial due to caseworker error – Miscalculations, lost documents, or misinterpretation of rules can result in wrongful denials. These often require a formal appeal.
• Correct denial – Even if the denial was correct, you may still become eligible later by using Medicaid planning strategies to reduce countable income or assets.

What Information Should You Look for in a Medicaid Denial Notice?

Your denial notice should clearly include:

• The specific reason for denial and the policy/rule cited.
• Your right to appeal through a fair hearing.
• Instructions and deadlines for filing your appeal.
• Information about self-representation or having someone (lawyer, family, Medicaid planner) represent you.

What Happens During a Medicaid Fair Hearing?

A Medicaid Fair Hearing is a recorded legal proceeding—often in person, by phone, or by video—where you and the Medicaid agency present your sides. The hearing officer:

• Hears testimony and reviews documents from both sides.
• Allows witnesses and cross-examination.
• Issues a written decision later (not on the same day).

Importantly, the hearing officer must be neutral and cannot have been involved in your original denial decision.

How Do You Request a Medicaid Fair Hearing?

You must file your request before the deadline in your denial notice—generally between 30 and 90 days from the notice date. To protect yourself:

• Submit your request in writing (even if other options are available).
• Get proof of submission (certified mail, date-stamped copy, etc.).
• Include your name, contact info, case number or SSN, reason for appeal, and a copy of your denial notice.

Can You Get an Expedited Medicaid Fair Hearing?

Yes—if your health, safety, or ability to function is at serious risk, you can request an expedited hearing. This requires supporting medical evidence and is scheduled as quickly as possible.

What Should You Do Before Your Medicaid Hearing?

• Review your Medicaid file and all documents the agency plans to present.
• Gather additional evidence, like medical records, bank statements, or letters from your doctor.
• Consider bringing witnesses who can confirm your care needs.
• Check if your state offers a pre-hearing review to resolve disputes without a hearing.

What Happens After the Medicaid Fair Hearing?

• If you win – You’re approved for Medicaid, often with coverage backdated to your application date (retroactive coverage).
• If you lose – You’ll get instructions on further appeal options.
• In some cases, more steps may be required (such as another medical evaluation) before a decision is made.