How to appeal a denial from Molina Healthcare

UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE

Molina Healthcare focuses on Medicaid managed care, ACA marketplace plans, and Medicare plans. The appeal path depends on which of those you have — and Medicaid members have an extra, powerful right on top of the plan appeal: a state fair hearing.

How appeals work at Molina Healthcare

• Check your letter for which line of business denied you — Medicaid, marketplace, and Medicare each follow a different appeal track, all described on the notice.
• Medicaid members: you generally must finish the plan's internal appeal first, then can request a state fair hearing — and if you appeal quickly (often within 10 days of the notice), you can usually keep receiving the disputed service while the appeal runs (aid paid pending).
• Marketplace members follow the standard route: internal appeal (at least 180 days to file), then independent external review.
• Ask Molina member services for the appeal form for your specific state plan, or file through the member portal.

The deadlines that apply to nearly every Molina plan

• At least 180 days to file the internal appeal from the date on the denial notice (non-grandfathered plans; the date printed on your letter controls).
• The plan must decide within about 30 days for care you haven't received yet, and about 60 days for care already received.
• Urgent case? Ask for an expedited appeal — a decision in roughly 72 hours when a physician confirms that waiting endangers your health.
• After the final internal denial: you can request independent external review — generally within about 4 months, per your letter.
• Employer self-funded plan? ERISA rules apply: state programs and regulators generally don't, and external review runs through the federal process. Your letter or HR can confirm the funding type.

Federal sources: HealthCare.gov internal appeals and HealthCare.gov external review. Your denial notice and plan documents control when they differ.

Best next reads: How to appeal, step by step and External review, explained — and decode any codes on the letter in the denial-code library.

Common questions

What is a state fair hearing and when can I use it against a Molina denial?

Medicaid members can have a state administrative judge review the denial after (in most states) completing Molina's internal appeal. Deadlines are strict and appear on the appeal-resolution notice. Filing fast — often within 10 days — usually lets you keep the disputed service during the process.

Do I keep my services while appealing a Molina Medicaid denial?

Often yes ('aid paid pending'): if you file the appeal within the short window printed on the notice, currently authorized services generally continue until the appeal is decided. Confirm the exact window on your notice — it's short.