If your Medicaid was terminated without notice, the state almost certainly broke federal law, and your fastest fix is to request a fair hearing right now. Federal regulation 42 CFR 431.211 requires your state Medicaid agency to mail you written notice at least 10 days before ending your coverage.1eCFR. 42 CFR 431.211 – Advance Notice If that notice never arrived, or arrived without the information it was supposed to contain, you have grounds to appeal, and if you act quickly enough your benefits must continue while the appeal is decided.
What the Notice Was Supposed to Say
The 10-day rule is only half of it. Under 42 CFR 431.210, the notice itself must contain specific information, and a notice missing any of these pieces is defective:
- The action being taken and its effective date.
- A clear reason for the termination.
- The specific regulation or change in law the agency is relying on.
- An explanation of your hearing rights and the deadline to request one.
- An explanation of how to keep your benefits running if you request a hearing.
If you never received a notice at all, or the notice you received is missing any of these elements, say so explicitly when you appeal.2eCFR. 42 CFR 431.210 – Content of Notice The procedural defect is itself a basis to challenge the termination, separate from any dispute about whether you’re eligible.
The Narrow Exceptions
Federal law recognizes only a short list of situations where the agency can skip the 10-day advance notice under 42 CFR 431.213. Those are: the agency has factual information confirming the beneficiary died; the beneficiary signed a statement declining services or acknowledging information that requires termination; the beneficiary was accepted for Medicaid in another state; mail was returned with no forwarding address and the beneficiary’s whereabouts are unknown; the beneficiary was admitted to an institution where they are ineligible for further services; or a physician prescribed a change in level of care.3eCFR. 42 CFR 431.213 – Exceptions From Advance Notice
A separate rule, 42 CFR 431.214, lets the agency shorten notice to five days when there is evidence of probable fraud, but it does not let the agency eliminate notice entirely.4eCFR. 42 CFR 431.214 – Notice in Cases of Probable Fraud If none of these situations fits you, the agency owed you 10 days’ written notice, and it did not deliver.
What to Do in the First 24 Hours
Speed decides how much this costs you. Two things are happening at once: your access to care is at risk, and your window to keep benefits running while you fight is short.
- Call your state Medicaid agency and ask why coverage ended. Write down the date, the name of the person you spoke with, and everything they tell you. If you never received a written notice, say so and ask for one.
- Check your mail and your online account for the agency. Notices sometimes go to old addresses or sit unopened in a portal. Look for renewal forms too.
- File the appeal request the same day if you can. Do not wait to gather every document first. You can add proof later; you cannot get back a missed deadline.
- Start collecting anything that supports your case: pay stubs, a current lease, proof you submitted a renewal, doctor’s letters. Send copies, keep originals.
Filing the Appeal
Federal law guarantees you a fair hearing when the agency terminates your coverage, denies a claim, or fails to act on your application with reasonable promptness.5eCFR. 42 CFR 431.220 – When a Hearing Is Required Most states accept hearing requests by mail, fax, phone, or online portal. You do not need a lawyer to file.
Your request should identify you (name, address, case number from any notice you did receive), state what action you are challenging, and briefly explain why you believe it was wrong. If you never got a notice, that is the reason. If you got one but it was missing required information, say which pieces were missing. Attach copies of anything you already have that supports your side. If you mail the request, use certified mail with return receipt so you have proof the agency received it and when.
The Two Deadlines
There are two separate deadlines, and mixing them up is the most common mistake.
The first is the deadline that keeps your benefits running. Under 42 CFR 431.230, if you request a hearing before the date of action listed on the notice, the agency generally cannot terminate your coverage until the hearing decision is issued.6GovInfo. 42 CFR 431.230 – Maintaining Services Because the agency must give at least 10 days’ advance notice, this is effectively a window of about 10 days from when the notice was mailed. If you never received a notice, and coverage has already been cut off, argue for reinstatement on the ground that the effective date has not properly run against you.
The second is the overall appeal deadline. You have up to 90 days from the date the notice was mailed to request a hearing.7GovInfo. 42 CFR 431.221 – Request for Hearing Filing after the shorter window still gets you a hearing. You just may not have coverage while it plays out.
The Recoupment Risk
Continuing benefits while you appeal is usually the right call, but understand the tradeoff. If the hearing officer sides with the agency in the end, the state may try to recover the cost of benefits you received between the date of action and the final decision. The agency must disclose this when you request a hearing.6GovInfo. 42 CFR 431.230 – Maintaining Services For most people, uninterrupted care is worth more than the recoupment risk, especially where the underlying case is strong. Go in knowing that risk exists.
Expedited Hearing When Health Is at Stake
If waiting for a standard hearing could put your life or health at serious risk, or threaten your ability to attain, maintain, or regain maximum function, you can request an expedited hearing under 42 CFR 431.224.8eCFR. 42 CFR 431.224 – Expedited Appeals Say so explicitly in your appeal, describe the medical situation, and include a letter from your doctor explaining the urgency. For eligibility claims on the expedited track, the agency must decide within 7 working days.
If You Are in a Managed Care Plan
One boundary worth knowing. If your Medicaid runs through a managed care organization and the MCO denied a specific service, the MCO’s own internal appeal comes first, and you have 60 days from the date on the plan’s adverse determination notice to file it.9eCFR. 42 CFR 438.402 – General Requirements That two-step applies to service denials by the plan. If the state Medicaid agency itself terminated your eligibility, so you lost coverage entirely rather than a single service, you go straight to the state fair hearing.
What Happens at the Hearing
A fair hearing is not a trial, but you have real rights under 42 CFR 431.242. You can review your case file and every document the agency plans to use, at a reasonable time before the hearing and during it. You can bring witnesses. You can present your own argument. You can question the agency’s witnesses and challenge their evidence.10eCFR. 42 CFR 431.242 – Procedural Rights of the Applicant or Beneficiary Hearings usually happen by phone, video, or in person, and the agency will send you the scheduling details.
Most people go through Medicaid hearings without an attorney. Free legal help exists, though. Your termination notice, if you received one, should list legal aid contacts for your area. You can also search for your local Legal Services Corporation office. Representation matters most when the case turns on complex income calculations or disputed medical evidence.
How Long It Takes
The agency must issue a final decision within 90 days of receiving your hearing request. Expedited eligibility hearings must be decided within 7 working days.11eCFR. 42 CFR 431.244 – Hearing Decisions Extensions are allowed only in narrow circumstances, such as a delay you requested or an emergency outside the agency’s control, and any delay has to be documented in your record. A decision in your favor requires the agency to reinstate coverage, and you may be owed retroactive benefits for any gap.
If the Appeal Fails
Losing does not leave you without coverage options. Losing Medicaid triggers a special enrollment period that gives you 60 days from the date coverage ended to pick a plan through the ACA Marketplace.12CMS. Special Enrollment Periods Job Aid Depending on income, premium tax credits can substantially cut the cost. Start at HealthCare.gov or your state’s marketplace.13HealthCare.gov. Getting Health Coverage Outside Open Enrollment
You can also reapply for Medicaid. There is no waiting period after a termination. If your income has dropped, you’ve lost a job, you’re pregnant, or your household has grown since the termination, a new application will be evaluated on your current situation, independent of the earlier appeal outcome.