Medicaid Appeal Timeframe Reverts Back to 30 Days

The Pennsylvania Department of Human Services (DHS) announced this month that the deadline to request a fair hearing appealing a Medicaid eligibility denial or termination is reduced from 90 days to 30 days from the date of the denial notice.  Thirty days to appeal the loss of Medicaid coverage is the appeal timeframe that was in effect prior to the federal Coronavirus public health emergency (PHE).

Readers may recall that in March 2020, a week after the initial PHE, DHS expanding the standard Medicaid appeal time frame from 30 days to 90 days. Since then, 90 days continued to be the timeframe a Medicaid denial or termination could be appealed until, on June 6, 2022,  DHS abruptly and without explanation reverted back to 30-day timeframe despite the federal PHE continuing.  The announcement of the return to a 30-day appeal timeframe also stated the change is effective retroactively to May 2022, raising concerns about the lack of advance notice.

PHLP joined its colleagues at the Community Legal Services urging DHS to continue the 90-day appeal timeframe.  In the meantime, applicants for and recipients of Medicaid should take the following steps to timely appeal a denial or termination of Medicaid coverage:

  • Postmark or hand deliver their appeal form within 30 days of the mail date included on the written denial notice. This can be done by following the instructions detailed on the notice of denial.
  • Specifically ask that Medicaid benefits continue during the appeal if the appeal is delivered after 15 days from the denial date.  Medicaid automatically continues if a person appeals within 15 days of a Medicaid termination.  During the PHE, Medicaid benefits will also continue if such continuation is specifically requested even after 15 days as long as the appeal is timely. 

If a Medicaid applicant or recipient appealed within 90 days before the June 6 change in the appeal deadline and the appeal was denied as untimely, contact PHLP for possible assistance getting the appeal reinstated. 

As previously reported, due to the continuous coverage protections during the PHE, many Medicaid recipients are not receiving termination notices for their Medicaid coverage at this time. However, if you do receive a notice of denial, the new, 30-day appeal time frame is applicable.

For questions or assistance with a Medicaid eligibility denial, call PHLP’s Helpline at 1-800-274-3258.