Medicaid Managed Care Appeal Clock
Medicaid managed care appeal deadlines.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Date on the adverse benefit determination notice
- 2026-10-01
- Intended effective date of the action
- 2026-10-20
Result: 42 CFR 438.402(c)(2)(ii): appeal to the plan within 60 calendar days of the date on the notice, so by November 30, 2026.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Date on the adverse benefit determination notice (YYYY-MM-DD)
- Intended effective date of the action (YYYY-MM-DD)
- Plan received the appeal (YYYY-MM-DD, or YYYY-MM-DDTHH:MM if expedited)
- Standard or expedited appeal
- Plan took the 14-day extension
- Date of the plan notice of resolution (YYYY-MM-DD)
- State fair hearing window, 90 to 120
How this is calculated
Citation
42 CFR 438.402 (appeal within 60 calendar days of the notice date), 438.408 (30 days standard, 72 hours expedited, up to 14-day extension; state fair hearing window of 90 to 120 days; deemed exhaustion), 438.420 (continued benefits); 431.221 (fee-for-service). Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.