How to Appeal a Medicaid Denial in Indiana: Deadlines, Forms, and the 10-Day Rule

You just received a notice that your child's Medicaid, waiver services, or level-of-care determination has been denied or reduced. The timeline to respond is strict and unforgiving — but the process itself is navigable if you understand the deadlines, the forms, and the strategy that gives you the strongest position at a fair hearing.

The Two Deadlines That Matter

33 calendar days. This is the outer limit for filing a written appeal. The request must be received by the Division of Family Resources or the Office of Administrative Law Proceedings by 4:30 p.m. local time within 33 calendar days from the date on the FSSA notice of agency action or the action's effective date, whichever is later. If the 33rd day falls on a weekend or state holiday, the deadline extends to the next business day. Miss this window and your appeal rights for that specific action expire.

10 calendar days. This is the critical window for preserving existing benefits. If you file your appeal within 10 days of the notice date — in practice, within 13 calendar days of the notice's mailing date — and before the effective date of the termination or reduction, your current level of Medicaid and waiver services continues unchanged during the entire appeal process. This is called "Aid Paid Pending." File after the effective date but within the 33-day appeal window and your appeal may still be valid, but services may be cut or terminated while you wait for a hearing.

In practice, the 10-day window means you need to act within about a week of receiving the notice, accounting for mail delivery time. Some families report receiving notices with only 5 or 6 days left before the 10-day window closes. Do not wait to research or consult an attorney before filing — file first, then prepare your case.

How to File the Appeal

Indiana accepts appeals through three channels:

Online. Submit through the FSSA Benefits Portal at fssabenefits.in.gov. This is the fastest method and provides a timestamped confirmation.

By phone. Call DFR customer service at 1-800-403-0864 and request to file an appeal. The representative will record your appeal request.

By mail or fax. Send a written appeal request (using State Form SF 53932 or a detailed letter) to the FSSA Document Center, PO Box 1810, Marion, IN 46952. Fax to 1-888-436-9199. If mailing, use certified mail with return receipt to prove the date of filing.

Your written appeal should include: the individual's name and case number, the date and reference number of the denial notice, a clear statement of what you are appealing and why, and a request for a fair hearing before an Administrative Law Judge (ALJ).

What to Include in Your Appeal

A bare appeal — "I disagree with the denial" — preserves your rights but gives the ALJ nothing to work with. A strong appeal includes:

The specific factual errors in the denial. If the denial stems from an interRAI level-of-care assessment, request the complete assessment record: the filled-out questionnaire, the assessor's clinical notes, and the scoring rubrics. Review each item. Where the assessor scored the individual as more independent than they actually are, document the discrepancy with specific evidence.

Supporting clinical documentation. Psychological evaluations, neuropsychological testing, behavioral data from school or therapy programs, physician letters documenting medical complexity, and any prior assessments that established a different level of need. The interRAI three-day lookback captures a snapshot; your job is to show the ALJ the full picture.

Incident logs and caregiver records. Behavioral incident reports, elopement logs, records of emergency interventions, and caregiver notes documenting daily support requirements. Concrete dates, times, and descriptions carry more weight than general statements about the individual's needs.

Letters from service providers. Case managers, therapists, day program staff, and physicians who work directly with the individual can submit letters describing the support they provide and what would happen if that support were reduced or eliminated.

The Fair Hearing

After your appeal is filed, the Office of Administrative Law Proceedings (OALP) schedules a fair hearing. The hearing is conducted by an ALJ who reviews the evidence, hears testimony from both sides (you and the state agency), and issues a written decision.

You have the right to represent yourself, bring an attorney, or bring a non-attorney advocate. You can present witnesses — the individual's case manager, therapist, teacher, or physician can testify about the individual's functional limitations. You can submit additional documentary evidence at the hearing that was not included in the initial appeal.

The hearing is your opportunity to demonstrate, with specifics, that the denial was based on incomplete or inaccurate information. The ALJ is evaluating whether the state's determination was consistent with applicable law and supported by the evidence — not whether the state followed its own procedures (though procedural errors also matter).

If You Win or Lose

If the ALJ reverses the denial, the state must restore services retroactively to the date they were terminated or reduced (if you did not have Aid Paid Pending, the gap is filled). The agency has limited grounds to appeal an ALJ decision in your favor.

If the ALJ upholds the denial, you can request a judicial review through the Indiana courts. This step typically requires legal representation. Before pursuing judicial review, consider whether new evidence or changed circumstances warrant a fresh application rather than continued litigation.

One important note: if you received Aid Paid Pending and the final appeal decision goes against you, the state may attempt to recover the cost of services provided during the appeal period. This recovery is subject to limitations and can sometimes be waived if it would create undue hardship — consult with a disability rights organization or attorney if this situation arises.

Getting Help

Indiana Disability Rights (formerly Indiana Protection and Advocacy Services) provides free advocacy assistance for individuals with disabilities facing denial of services. The Arc of Indiana and IN*SOURCE (Indiana's Parent Training and Information Center) can also provide guidance on navigating the appeal process.

For comprehensive appeal preparation, including evidence-gathering templates and the full interRAI prep strategy, the Indiana SSI at 18 & Adult Disability Benefits Guide covers both state Medicaid appeals and federal SSI appeals in the context of Indiana's specific deadlines and procedures.

See more Indiana guides →