Losing Medicaid (or Just Got Denied)? Your Appeal Rights and the 90-Day Backup Plan

A parent in the diabetes-family threads we studied got six days' notice that their child's Medicaid was ending. Six days, with insulin in the fridge. The replies split between panic and the two facts this article exists to spread: terminations can be appealed with coverage continuing in the meantime, and even a legitimate loss opens a generous bridge to other coverage. Medicaid's paperwork machine is brutal, and it is also more contestable than almost anyone realizes.

First: read the notice like a lawyer (it takes two minutes)

• The date of action: when coverage actually ends. Federal rules require advance written notice, generally at least 10 days before that date. Six days' notice, or a notice that arrived after the fact, is a procedural defect worth stating in your appeal.
• The stated reason: "over income," "failed to return renewal," "failed to provide verification," "no longer eligible category." Your entire strategy depends on which one it is.
• The appeal instructions: every notice must explain how to request a fair hearing and the deadline (commonly 90 days from the notice, but the magic date is earlier, below).

The right almost nobody uses: aid paid pending

If you request your fair hearing before the termination date on the notice, federal Medicaid rules generally require the state to continue your coverage until the hearing is decided. This is called aid paid pending, and it converts "coverage ends Friday" into "coverage continues while we argue." Two honest caveats: you must usually ask within the pre-termination window (some states frame it as within 10 days of the notice), and if you lose the appeal the state can seek repayment of the continued benefits, a risk worth taking when the termination looks wrong and the care is critical. Request the hearing in writing (or through the state portal), say explicitly "I request continued benefits pending my hearing," and keep proof of the date.

If the reason is paperwork, fight it as paperwork

A huge share of Medicaid losses are procedural: the renewal packet went to an old address, a pay stub didn't upload, a deadline slid by during a hospitalization. These people are often still eligible. The moves: submit the missing renewal or documents immediately (states must generally reinstate paperwork-terminated coverage without a full new application if you complete the renewal within 90 days of termination); update your address with the agency today; and appeal anyway to preserve the aid-paid-pending option while the documents process. If the agency's own error caused it (the corpus is full of "they say I have Medicaid and I don't" and accidental terminations), say the words "agency error" in the hearing request and demand retroactive reinstatement, which Medicaid can do, covering the gap's bills.

If the reason is income, check the doors people miss

• Kids rarely lose coverage when parents do: CHIP covers children at much higher family incomes, in most states up to roughly 200% to 300%+ of the federal poverty level (about $80,000 for a family of four in many states). A parent's income bump that ends adult Medicaid often changes nothing for the children.
• Monthly math matters: most Medicaid categories run on current monthly income. Overtime that ended, a job that didn't last, seasonal work: reapply the month the income drops, since there's no penalty for reapplying.
• Disability and age categories play by different rules: medically needy "spend-down" programs, Medicaid buy-in programs for workers with disabilities, and Medicare Savings Programs (for those also on Medicare) all have different income treatments. A denial in one category is not a denial in all of them; your state's SHIP counselor (for Medicare-Medicaid questions) or legal aid office can map them.
• Pregnancy and postpartum have their own, higher limits and, in most states, 12 months of postpartum coverage regardless of income changes.

The 90-day bridge: marketplace coverage after Medicaid

If the loss is real, losing Medicaid or CHIP is a qualifying event with an unusually generous window: up to 90 days after coverage ends to pick a marketplace plan (the general loss-of-coverage rule gives 60; Medicaid/CHIP loss gets more). Income just above Medicaid limits usually qualifies for the largest subsidies on the exchange, frequently plans with very low premiums. Apply with your expected annual income, check that your doctors and prescriptions are covered (verify by phone), and mind the gap: marketplace coverage starts prospectively, so applying the week Medicaid ends beats applying in month two. Job-based coverage, if newly available, has its own 30-day special enrollment after Medicaid loss too.