How to Appeal Medicaid Denial Maryland: Fair Hearing and 10-Day Rule

The Two Deadlines You Must Know

When Maryland denies a Medicaid application or reduces existing benefits, the Notice of Action letter you receive contains a decision that isn't final — but only if you act within the right timeframe. There are two critical deadlines, and confusing them can cost your family months of coverage:

10 calendar days — If your parent is currently receiving Medicaid benefits and the state is reducing or terminating them, you must request a hearing within 10 calendar days of the notice date to keep benefits running at the current level while the appeal is decided. Miss this window and your parent's coverage stops (or drops) on the effective date listed in the notice, even if your appeal is eventually successful.

90 days — You have 90 days from the notice date to request a fair hearing for any adverse Medicaid decision. This applies to initial denials, benefit reductions, and terminations. Filing within this window preserves your right to appeal, but it doesn't preserve ongoing benefits the way the 10-day deadline does.

The 10-day rule is the one that matters most in crisis situations. If your parent is in a nursing home on Medicaid and the state sends a notice saying coverage is being terminated because of a redetermination issue, you have 10 days — not 90 — to file the appeal and maintain uninterrupted care.

Common Reasons Maryland Denies Long-Term Care Medicaid

Excess assets. The caseworker determined that countable resources exceed the $2,500 individual limit. This often happens when IRAs are counted (Maryland treats IRA cash value as fully countable) or when jointly held accounts are fully attributed to the applicant.

Transfer penalty. The lookback review found uncompensated transfers within the 60-month window, and the state imposed a penalty period. The denial isn't permanent — it lasts for the calculated penalty period — but the family must cover nursing home costs privately during that time.

Failure to provide documentation. The application was marked incomplete because the family didn't submit requested bank statements, proof of burial trusts, or other financial records within the caseworker's deadline.

Medical necessity not established. The Community Health Nurse's assessment determined the applicant doesn't require a nursing facility level of care. This can happen when a parent's functional limitations are borderline or when the assessment was conducted on a "good day."

Income exceeds waiver limits. For community-based programs like the Community Options Waiver, monthly income above $2,982 disqualifies the applicant. (For institutional nursing home Medicaid, Maryland's medically needy spend-down pathway handles excess income differently.)

How to Request a Fair Hearing

Step 1: File the request. Submit a written request for a fair hearing to the Maryland Department of Human Services. Use Form DHS/FIA 334 (Request for Fair Hearing), available from your local DSS office or the DHS website. You can also submit a written letter stating you're requesting a fair hearing, referencing the case number and the specific decision you're contesting.

Step 2: State what you're contesting. Be specific. "I disagree with the denial" isn't enough. Identify the exact issue: "The denial counted my mother's IRA as a resource, and I am contesting the balance the agency used" or "The transfer penalty calculation included a $15,000 payment that was fair market compensation under a personal care agreement."

Step 3: Gather your evidence. Pull together every document that supports your position:

• Bank statements showing the account in question
• The personal care agreement, if transfers are at issue
• Medical records supporting the level of care determination
• Letters from physicians confirming ADL limitations
• Documentation proving the timely submission of any records the caseworker claims were missing

Step 4: The hearing itself. The fair hearing takes place before an Administrative Law Judge at the Maryland Office of Administrative Hearings (OAH). It's less formal than a courtroom trial but follows a structured process. You can represent yourself, bring an attorney, or have a legal aid representative. The caseworker presents the state's case, you present yours, and the judge issues a written decision.

Keeping Benefits Active During the Appeal

If you filed within the 10-day window, your parent's existing benefits continue at the same level throughout the appeal process. This is called "aid continuing" or "benefit continuation." The state cannot reduce, terminate, or suspend coverage until the hearing decision is issued.

If the hearing decision goes against you, the state may seek to recover any benefits paid during the appeal period. But having coverage continue during the process — rather than having a gap that forces the family to scramble for private pay — is often worth the risk.

If you filed after 10 days but within 90 days, you still get a hearing, but benefits won't continue at the pre-notice level. Your parent's coverage will reflect the state's decision until the appeal is resolved.

When the Denial Involves a Transfer Penalty

Transfer penalty appeals are among the most common and most winnable in Maryland Medicaid. Families often have strong arguments that the caseworker overlooked:

• The transfer was for fair market value. If your parent sold property or paid a caregiver under a written agreement at market rates, the transaction wasn't uncompensated.
• The transfer falls under an exemption. Spousal transfers, transfers to a disabled child, and transfers under the caregiver child exception are all penalty-exempt. If the caseworker didn't apply the exemption, the appeal is the mechanism to get it recognized.
• The assets have been returned. If the family returned the gifted assets (or a portion of them) after the denial, the penalty should be recalculated or eliminated.
• Undue hardship. If the penalty leaves your parent without access to necessary medical care and the transferred assets genuinely can't be recovered, an undue hardship waiver may apply.

Free Legal Help for Maryland Medicaid Appeals

Several organizations provide free legal assistance for Medicaid appeals in Maryland:

• Disability Rights Maryland — provides legal help for CFC and waiver appeals, including templates and hearing preparation guides
• Maryland Legal Aid — handles Medicaid eligibility disputes for low-income families across the state
• Pro Bono Resource Center of Maryland — connects families with volunteer attorneys for administrative hearings

An attorney isn't required for a fair hearing, but having one significantly improves outcomes — especially for transfer penalty disputes where the legal arguments involve contract law, asset valuation, or statutory exemptions.

For families preparing a Medicaid application and wanting to avoid denials in the first place, the Maryland Medicaid Long-Term Care & Asset Protection Guide includes an appeal packet template with sample hearing request letters and documentation checklists specific to the most common denial reasons in Maryland.

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