If you have been dropped from Medicaid, your next steps depend on why coverage ended and how quickly you act. You have appeal rights that can keep benefits running if you move before the termination date, a 90-day window to pick a Marketplace plan, and, in many cases, a strong chance of getting coverage restored if the state ended it for missing paperwork rather than actual ineligibility. Start with the notice in your hand.
Read the Termination Notice Before Anything Else
The letter from your state Medicaid agency tells you three things you need:
- The reason for termination. A substantive reason (income too high, household change, moved out of state) points you toward reapplying or shopping for other coverage. A procedural reason (missed renewal form, missing documents) points you toward an appeal, because you may still be eligible.
- The effective date, sometimes called the date of action. This is when coverage actually ends, and it controls whether you can keep benefits running during an appeal.
- Appeal instructions and the deadline to request a fair hearing. States set this window somewhere between 30 and 90 days from the date on the notice.1Medicaid.gov. Understanding Medicaid Fair Hearings
If the reason on the notice looks wrong, or if you never received a notice at all, that itself can be grounds for appeal. Do not assume the termination is final because a few weeks have passed.
Appeal If the Termination Looks Wrong
Every state must offer a fair hearing when Medicaid ends your coverage.2Office of the Law Revision Counsel. 42 U.S. Code 1396a – State Plans for Medical Assistance You should request one if you think the state used incorrect income information, missed documents you actually sent, or ended coverage based on a renewal notice you never received.
Request the Hearing Before Your Coverage Ends
This is the piece most people miss. If you file your hearing request before the effective date on the notice, the state must continue your Medicaid benefits until the hearing decision comes out.3eCFR. 42 CFR 431.230 – Maintaining Services The gap between when the notice lands and when coverage ends can be as short as 10 days.1Medicaid.gov. Understanding Medicaid Fair Hearings Open Medicaid mail immediately and check your online portal often.
What Happens After You File
The state generally has 90 days to make a final decision on your case.4eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries You can present evidence in person, by phone, or in writing depending on the state. Gather pay stubs showing your actual income, proof you sent documents the state says it never received, or anything else that supports your version of events.
One caution before requesting continued benefits: if you lose the hearing, some states may seek repayment for the Medicaid services paid during the appeal. Weigh that against your need for uninterrupted coverage.
Reapply If Something About Your Situation Changed
An appeal challenges the state’s decision. A new application is the right move when your circumstances have actually changed since the termination, such as a job loss, reduced hours, a pregnancy, or a new dependent. You can reapply through your state’s Medicaid website, by phone, by mail, or in person. There is no waiting period after a termination and no limit on how many times you can apply.
Ask About Retroactive Coverage
If you racked up medical bills before reapplying, Medicaid may pay them retroactively. Federal rules allow coverage for up to three months before the month you file, as long as you would have qualified during those months and the services are covered by your state’s plan. If approved, Medicaid pays providers directly, and some states will reimburse bills you already paid.
Check Whether Your Children Still Qualify
Losing your Medicaid does not automatically mean your children lose theirs. Children have their own eligibility rules, and the Children’s Health Insurance Program covers kids in families well above the adult Medicaid limit. CHIP reaches at least 200 percent of the federal poverty level in every state, and some states go up to 400 percent.5Medicaid.gov. CHIP Eligibility and Enrollment If your income only rose a modest amount, your kids probably still qualify. Contact your state Medicaid agency or apply through HealthCare.gov to check.
Enroll in a Marketplace Plan Within 90 Days
Losing Medicaid opens a Special Enrollment Period on the Health Insurance Marketplace, and you get 90 days from the date coverage ended to pick a plan.6HealthCare.gov. Send Documents To Confirm a Special Enrollment Period That is longer than the standard 60-day window for most other life events, so use the time to compare plans.
Create an account at HealthCare.gov, or your state’s Marketplace if it runs one, and enter household income and family details. The system will calculate two kinds of help: premium tax credits that lower your monthly payment, and cost-sharing reductions that lower deductibles and copays.
Look Hard at Silver Plans
Cost-sharing reductions only apply to Silver-tier plans, and they can push a Silver plan close to what Medicaid covered. For households up to 150 percent of the federal poverty level, a Silver plan’s actuarial value climbs to 94 percent. Between 150 and 200 percent it covers 87 percent, and between 200 and 250 percent it covers 73 percent. A standard Silver plan without reductions covers 70 percent, and Bronze covers about 60 percent.7HealthCare.gov. Health Plan Categories: Bronze, Silver, Gold, and Platinum If you just lost Medicaid, chasing the cheapest Bronze premium can cost you more overall the first time you need care.
Report Income Changes During the Year
If you take advance premium tax credits to lower your monthly premium, you must file IRS Form 8962 with your tax return to reconcile what you received against what you actually qualified for.8Internal Revenue Service. Instructions for Form 8962 (2025) Starting in plan year 2026, there is no cap on how much excess credit you have to pay back if your final income comes in higher than what you estimated.9CMS Agent Broker FAQ. Are There Limits to How Much Excess Advance Payments of the Premium Tax Credit Consumers Must Pay Back Prior repayment caps are gone. Update your income in the Marketplace account whenever it changes so April doesn’t bring a surprise bill.
Other Coverage Routes
Your Employer’s Plan
If your job offers health insurance, losing Medicaid opens a 60-day window to enroll through your employer.10United States Department of Labor. Losing Medicaid or CHIP Tell HR right away and bring documentation of your Medicaid termination date.
COBRA From a Former Job
COBRA can extend coverage from a previous employer’s group plan for 18 to 36 months, but you pay the full premium plus up to a 2 percent administrative fee.11U.S. Department of Labor. COBRA Continuation Coverage Federal COBRA only applies to employers with 20 or more employees.12U.S. Department of Labor. FAQs on COBRA Continuation Health Coverage Smaller employers may fall under a state mini-COBRA law instead. Because COBRA premiums are usually steep, price it against a Marketplace plan with premium tax credits before you commit.
Getting Care While You Are Uninsured
Federally qualified health centers use a sliding fee scale based on income and family size. Income at or below 100 percent of the federal poverty level qualifies you for a full discount that brings your bill to a nominal charge or zero, and partial discounts extend up to 200 percent.13Bureau of Primary Health Care. Chapter 9: Sliding Fee Discount Program More than 16,200 service sites operate across every state and territory, and you can locate the nearest one at findahealthcenter.hrsa.gov.14Health Resources and Services Administration. Find a Health Center Many also participate in the 340B Drug Pricing Program and can dispense prescriptions at reduced cost.15Health Resources and Services Administration. 340B Eligibility
For emergencies, hospitals that take Medicare must screen and stabilize anyone who arrives at the emergency department, regardless of insurance or ability to pay. That does not make the visit free. After treatment, ask about charity care and payment plans before you accept the billed amount as final.