Medicaid denied or stopped benefits. Can they continue while I appeal?
Often yes if the service is being reduced, suspended, or terminated and you request the appeal quickly enough: Medicaid managed care has an aid-continuing rule when the appeal is timely and the service was previously authorized. Ask for continuation of benefits in writing when you file the appeal, and read your state's notice because deadlines are short.
What to do, in order
- Step 1
Read whether it is a reduction, termination, or new-service denial
Aid continuing is strongest when an already-authorized service is being reduced, suspended, or stopped.
- Step 2
File fast
The continuation deadline is usually much shorter than the outer appeal deadline. The notice states the exact date.
- Step 3
Ask for benefits to continue by name
Write that you request continuation of benefits during the appeal under Medicaid managed care rules.
- Step 4
Prepare the fair-hearing record
Collect medical records, service plan, prior authorization, and provider statement before the hearing.
The deadline that applies
Medicaid managed care appeals must allow at least 60 calendar days after the adverse benefit determination (42 CFR 438.402), but continuation of benefits requires a timely request under 42 CFR 438.420 and state notice rules. The notice controls.
Calculate your date →Documents to gather
- Medicaid notice
- Prior authorization or current service plan
- Provider statement
- Records showing need for continued service
- Written continuation request
Go deeper
Related questions
Can I owe money if I lose?
States can seek recovery for services continued during appeal in some circumstances. Read the notice and ask the state fair-hearing office.
Does aid continuing apply to a brand-new service request?
Usually no. It usually applies to previously authorized services being reduced, suspended, or terminated.
Can someone appeal for a family member?
Yes, with the authorization or representative process required by the state or managed care plan.
Sources
Share your denial and ask our team about appeal preparation and filing support. $0 upfront. Review the fee and terms before deciding. Apellica is not a law firm and cannot guarantee an outcome.
Start a free denial review →