Medicaid Won't Pay for Medical Care or a Medical Item I Need. What Can I Do?
Medicaid Says My Medical Care or Item Is Not Medically Necessary. What Can I Do?
Medicaid Says My Medical Service or Item Is Not Covered by Medicaid. What Can I Do?
Do You Want to Appeal?

Medicaid Won’t Pay for Medical Care or a Medical Item I Need. What Can I Do?
You can appeal Medicaid’s decision. An appeal is when you tell Medicaid you disagree with their decision.

Does Medicaid say it won’t pay for your medical care or item? Then they must send you a written notice or letter. The notice must say why Medicaid won’t cover the medical care or item you need. There are two main reasons Medicaid won’t cover medical care. Medicaid won’t cover something if it is not necessary or if it is not covered by Medicaid.

Medicaid Says My Medical Care or Item Is Not Medically Necessary. What Can I Do?
You can appeal Medicaid’s decision that your care or item is not necessary. When you appeal, you ask for a Fair Hearing. A Fair Hearing is a legal proceeding where a hearing officer decides. At the Fair Hearing you will be able to say why you believe Medicaid should cover your medical service or item.

Medicaid Says My Medical Service or Item Is Not Covered by Medicaid. What Can I Do? Is the service or item you need not usually covered by Medicaid? It may still be covered in your case. You can ask for an exception, using the M108 process. M108 is the letter and number of the Medicaid rule for exceptions. If Medicaid denies your M108 request, you can appeal.

Do You Want to Appeal?
Request a Fair Hearing. You can appeal by calling Member Services at (800) 250-8427. You have 90 days to appeal. The 90 days starts on the date Medicaid sent you the written notice saying they wouldn’t pay for your medical service or item. Learn more about Fair Hearings and appeals on our Appeals page. Learn more about M108 on our M108 page.