Appeal to your Medicaid health plan within 60 days of the denial notice, by phone or in writing. The plan must decide within 30 days, or 48 hours if expedited. If it upholds any part of the denial, you can ask AHCA for a fair hearing within 120 days. Appealing within 10 days can keep approved services going.
Step 1: Read the notice
When a Medicaid plan denies, reduces or stops a service, it must send a Notice of Adverse Benefit Determination saying what it decided and why. The 60 days to appeal count from the date on that notice, so note the date and keep the envelope. This page covers Florida Medicaid health plans; a private insurer has its own rules.
Step 2: Appeal to the plan
Appeal by phone or in writing; the plan must help you. If you call, follow up in writing. The plan must confirm a written appeal within 5 days and decide within 30 days, though it may ask for an extension. If waiting could harm your child, ask for an expedited appeal; if the plan agrees, it decides within 48 hours. The answer comes in a Notice of Plan Appeal Resolution.
- Useful evidence: the denial letter, the behavior assessment and treatment plan, and a letter from your child's doctor or BCBA on why the hours are medically necessary.
- If the plan misses its deadlines or never sends a notice, you can go straight to a fair hearing.
Step 3: Keep services going
If approved ABA was reduced or stopped, ask for services to continue and file within 10 days after the notice was mailed, or before the cut begins. Services continue only while the current approval period lasts, and your provider cannot ask for this on your behalf. If the decision is upheld in the end, AHCA says the cost of those services may be billed, but Medicaid cannot be taken away if you cannot pay.
Step 4: Ask for a fair hearing
If the plan upholds any part of its decision, you have 120 days to ask AHCA for a Medicaid fair hearing; to keep services going meanwhile, ask within 10 days of the plan's decision letter. Finish the plan appeal first, or the request may be turned down. Call the Medicaid Helpline at 1-877-254-1055 or email MedicaidHearingUnit@ahca.myflorida.com. Include your name, phone and address, your child's name and Medicaid ID, and what was denied, reduced or stopped.
Once the hearing is set, the plan must send you its full case file free of charge. The decision usually comes in about 90 days.
Where can I get help?
Florida Health Justice Project has an online legal-help intake, and your plan must help you file. Paramount Behavior is a bilingual ABA agency in Greenacres; call (561) 421-0047. Keep the denial letter and call us with questions; we also check your child's coverage for free, usually the same day you call.
Do letters from my child's doctor or BCBA help?
They can. Florida Health Justice Project lists a letter of medical necessity from your doctor as evidence; for a hearing, send evidence at least 10 days before the hearing date.
Can someone else ask for or attend the hearing for me?
Yes. Florida Health Justice Project says you must send AHCA a Designated Authorized Representative form that you sign.
General information as of October 21, 2026, not legal advice. Deadlines run from the dates on your own notices, so read them and ask your plan, AHCA or legal aid about your case.
Sources
- SMMC Program Snapshot: Process for Enrollee Grievances and Appeals. Florida Agency for Health Care Administration (AHCA), accessed October 21, 2026.
- Medicaid Fair Hearings. Florida Agency for Health Care Administration (AHCA), accessed October 21, 2026.
- 42 CFR 438.402 General requirements (grievance and appeal systems). U.S. Centers for Medicare & Medicaid Services / Code of Federal Regulations (via Cornell LII), accessed October 21, 2026.
- How to File an Appeal with Your Medicaid Managed Care Plan. Florida Health Justice Project, accessed October 21, 2026.