CHIP Appeals When Your Child Is Denied or Coverage Ends: What to Do Next

If your child’s CHIP (Children’s Health Insurance Program) application was denied or your child’s CHIP coverage has ended, you usually have the right to appeal or request a review. This article explains how CHIP appeals typically work, what steps to take, and where to turn through official channels.

HowToGetAssistance.org is an independent information site. It is not a government agency, application portal, or benefits office. For appeals, you will need to work directly with your state’s CHIP agency or Medicaid office.

Understanding CHIP and Why Appeals Matter

CHIP is a public health coverage program for children in families who earn too much to qualify for Medicaid but cannot afford private insurance. In some states, CHIP and children’s Medicaid are closely linked or managed together.

If you receive a denial notice or a notice that coverage is ending, you do not have to accept it without question. In many cases you can:

• Ask for an explanation or informal review
• Submit missing or updated information
• File a formal appeal within a set deadline

Acting quickly is important because appeal deadlines are strict and coverage options can change if you wait too long.

Common Reasons CHIP Applications Are Denied or Coverage Ends

Understanding why the decision was made helps you decide your next step.

Typical reasons for a CHIP denial

A child might be denied CHIP if:

• Household income appears too high for the program’s limits
• Missing documents (pay stubs, proof of address, immigration documents) were not received in time
• The child is already enrolled in other credible coverage (such as employer-sponsored insurance)
• The child does not meet age requirements for CHIP in your state
• There is an issue verifying citizenship or immigration status (where required)
• The program cannot confirm the child lives in the state (residency issue)
• The application was incomplete or unsigned

Typical reasons CHIP coverage ends

A child’s existing CHIP coverage may end if:

• The family did not return a renewal form or requested documents
• Income increased above the CHIP income limit
• The child aged out of CHIP (usually at age 19, though this varies)
• The family moved out of the state
• The child now has other qualifying health coverage
• There was an error or misunderstanding in the records

Your official notice of denial or termination should list the reason the agency used. This notice is your starting point for any appeal.

First Step: Read Your Notice Carefully

When your child is denied CHIP or coverage ends, the state agency will usually send a written notice by mail and sometimes electronically.

Look for these key details on the notice:

• Reason for the decision (for example, “income over limit” or “incomplete information”)
• Effective date (when coverage ends or when the denial applies)
• Your appeal rights – often called:
  • “Right to a fair hearing”
  • “Appeal rights”
  • “How to request a hearing or reconsideration”
• Deadline to appeal – for example, 30, 60, or 90 days from the date of the notice (this varies by state)
• How to appeal – usually by:
  • Mail (sending a written request)
  • Online (through your state’s official benefits portal)
  • Phone (calling an official number to request a hearing)
  • In person (at your local Medicaid/CHIP or county office)

If your notice is missing or hard to understand, you can call your state’s CHIP or Medicaid customer service line and ask them to:

• Explain the decision in plain language
• Send you a replacement copy of the notice if you lost it
• Tell you exactly how and where to file an appeal

When You Can Appeal a CHIP Decision

In most states, you can ask for an appeal or hearing when:

• Your application is denied
• Your child’s CHIP coverage ends
• Your benefits are reduced (for example, different cost-sharing or eligibility category)
• You believe there has been an error with income, household size, or information

Even if you think the decision might be correct, requesting a review can help confirm that:

• All your information is accurate and up to date
• Any missing documents are correctly submitted
• You understand any other coverage options (such as Marketplace plans or Medicaid)

Options: Correcting a Problem vs. Filing a Full Appeal

Depending on the situation, you might handle it in more than one way.

1. Fixing simple issues (informal review or case correction)

If the denial was caused by something like:

• Missing pay stubs
• Outdated contact information
• A simple data error (wrong income, wrong family member listed)
• A document that arrived late

You can often:

1. Contact your state agency (phone or in person).
2. Explain that you believe there is a simple mistake or missing document.
3. Ask whether you should:
   • Submit the missing document only, or
   • File a formal appeal as well

Sometimes the agency can correct a simple issue without a full hearing. However, you should not rely on this alone if the appeal deadline is approaching. When in doubt, submit an appeal request on time and continue working to fix any errors.

2. Filing a formal CHIP appeal or fair hearing

If you disagree with the decision or the issue is more complex, you may need a formal appeal. This is often called a “fair hearing” and is usually handled by a neutral hearing officer or administrative law judge.

You would typically appeal if you believe:

• Your income was calculated incorrectly
• Your documents were submitted on time but not recorded
• The agency misapplied the rules to your case
• There are special circumstances the agency did not consider

How to Start a CHIP Appeal: Step-by-Step

Because CHIP is run by states, exact steps and forms vary, but the general process is similar.

Step 1: Check your appeal deadline

Locate your appeal deadline on the notice. It might say something like:

• “You have 30 days from the date of this notice to request a fair hearing.”
• “Your appeal must be received within 60 days.”

Mark this date clearly. Missing the deadline is one of the most common reasons appeals are not successful.

Step 2: Decide how you will submit your appeal

States usually offer one or more of these options:

• Online through the official state benefits portal
• By mail (sending a written request or a specific appeal form)
• By fax (in some states)
• By phone (calling the program’s official appeals line)
• In person at your local Medicaid/CHIP or county assistance office

To identify the correct office or portal, you can:

• Look on your denial or termination notice
• Check your state’s official health or human services website
• Call 211 and ask for your state’s Medicaid/CHIP agency contact information
• Ask at your local county social services or department of human services

Step 3: Prepare your appeal request

Your appeal request generally should include:

• Your full name
• Child’s full name
• Case number or client ID (from your notice)
• Current address and phone number
• A statement like:
  • “I am requesting an appeal/fair hearing about the denial of my child’s CHIP coverage dated [notice date].”
• A brief explanation of why you disagree, such as:
  • “Income information is incorrect.”
  • “All requested documents were submitted.”
  • “We believe we meet CHIP income rules.”

You do not need to write a long legal argument. A clear, simple explanation is usually enough to open the appeal.

Step 4: Gather supporting documents

Collect documents that support your position, for example:

• Recent pay stubs or proof of income
• Tax returns if relevant
• Proof of child’s age (birth certificate, school record)
• Proof of citizenship or immigration status, if required
• Proof of state residency (lease, utility bill)
• Copies of anything you already submitted to the agency
• A copy of the denial or termination notice

You may be able to submit these documents:

• Online through the official benefits portal
• By mail or fax to the address or number on your notice
• In person at your local office

Step 5: Ask about continued coverage during the appeal (if applicable)

In some states and situations, if you appeal by the deadline, your child’s current coverage can sometimes continue until the appeal is decided. This may be called:

• “Aid continuing”
• “Continuation of benefits”

Ask your state agency whether this applies to your case. If you don’t ask, the coverage may stop while the appeal is pending.

What to Expect After You File an Appeal

After you submit your appeal, a few things typically happen:

1. Acknowledgment

   • You may receive a confirmation letter or message that your appeal was received.
   • This letter may include a case or hearing number.

2. Review or reconsideration

   • Sometimes the agency will first re-review your case, especially if you submitted new documents.
   • If they agree with you, they may change the decision without needing a hearing.

3. Scheduling a hearing

   • If the decision is not changed, a hearing is scheduled.
   • You will receive a notice with the date, time, and instructions.
   • Hearings may be:
     • By phone
     • By video conference
     • In person at a designated location

4. During the hearing

   • You can:
     • Explain your situation
     • Present documents and evidence
     • Bring witnesses in some cases (for example, a caseworker or other person with direct knowledge)
   • A hearing officer or judge will listen to both you and the agency’s representative.

5. Decision

   • After the hearing, the hearing officer will issue a written decision.
   • The decision typically states whether:
     • The agency’s denial or termination is upheld, or
     • The agency is ordered to approve or reinstate coverage (if you meet all rules)

If you disagree with the hearing decision, some states offer one more level of review. Your decision notice will explain if and how you can request that.

Quick Comparison: Informal Fix vs. Full Appeal

If there is any chance you might miss your appeal deadline, consider filing the formal appeal first and then working with the agency on informal corrections.

Important Deadlines and Timelines

While exact deadlines vary by state, here are patterns you may see:

• Appeal request deadline: often 30–90 days from the date on the notice
• Time to submit documents: could be 10–30 days after a request for more information
• Hearing scheduled: often within a few weeks to a few months after the appeal request
• Decision issued: usually within a defined timeframe after the hearing

To avoid problems:

• Appeal as early as possible—do not wait until the last day.
• Keep copies of:
  • Your appeal request
  • Any proof of mailing or submission
  • All documents you send
• If you do not receive any acknowledgment, contact your state agency or local office to confirm they received your appeal.

If You Don’t Qualify for CHIP After the Appeal

If your appeal is denied or you are confirmed ineligible for CHIP, you may still have other options for your child’s health coverage.

1. Children’s Medicaid

In some cases, your income or family situation may fit Medicaid rather than CHIP. In many states:

• Children in very low-income households may qualify for children’s Medicaid.
• CHIP and Medicaid are handled by the same or related agencies.

Ask your state’s Medicaid/CHIP office whether your child should be evaluated for Medicaid based on your income and situation.

2. Health Insurance Marketplace Plans

If your child is not eligible for CHIP or Medicaid, you may be able to apply for coverage through the Health Insurance Marketplace (often managed at the federal or state level). Depending on your income:

• You may qualify for premium tax credits or cost-sharing reductions.
• Children may enroll in private plans with financial assistance.

Look for your state’s official Marketplace website or helpline, or the national Marketplace call center.

3. Employer-Sponsored Coverage

If you or another parent has access to employer-sponsored health insurance, check:

• Whether adding your child is allowed outside of open enrollment, for example due to a loss of other coverage.
• What costs (premiums, deductibles, copays) would be.

4. Local Clinics and Sliding-Scale Services

Even without CHIP, children may receive care through:

• Community health centers
• Federally Qualified Health Centers (FQHCs)
• Local public health clinics
• School-based health clinics

Many of these offer sliding-scale fees based on income, regardless of insurance status.

You can call 211 to ask about low-cost or sliding-scale clinics in your area.

How to Make Your Appeal Stronger

A few practical tips can help your CHIP appeal move more smoothly:

• Stay organized

  • Keep a folder with notices, copies of forms, pay stubs, and letters.
  • Write down every phone call: date, time, name of the person you spoke with, and what they said.

• Submit clear, complete documents

  • Make sure documents are legible and show full names and dates.
  • Include case numbers on every page you send, if possible.

• Follow instructions exactly

  • Use the correct mailing address, fax number, or online portal.
  • If the notice says documents must be “received by” a certain date, aim to send them well before.

• Ask for help if needed

  • Some areas have legal aid organizations or health insurance navigators who assist with benefits appeals.
  • You can ask 211 or your local legal aid office if help is available for Medicaid/CHIP appeals in your area.

Verifying You’re Using Official Channels (Avoiding Scams)

Because CHIP is a government-related program, your appeal should always go through official offices and websites. To protect yourself:

• Use contact details from:
  • Your official CHIP/Medicaid letters
  • Your state’s health or human services website
  • Your local county social services office
• Be wary of anyone who:
  • Guarantees approval for a fee
  • Asks for bank account or credit card numbers to “speed up” your appeal
  • Contacts you from unofficial email addresses or social media messages claiming to be the state agency
• If you are unsure, call your state’s CHIP or Medicaid customer service number from a trusted source (such as the number printed on your official notice) and verify instructions before sharing any personal details.

Key Takeaways

• A denial or end of CHIP coverage is not always final; you usually have the right to appeal.
• Act quickly: appeal deadlines are strict, often within 30–90 days of the notice.
• Start by reading your notice carefully, understanding the reason, and gathering supporting documents.
• You can often:
  • Try to correct simple issues directly with the agency, and/or
  • File a formal appeal or fair hearing request.
• During the appeal process, ask if your child can keep coverage temporarily while the decision is reviewed (where state rules allow).
• If your child remains ineligible, explore Medicaid, Marketplace plans, employer coverage, and local clinics as alternatives.
• Always work through official state agencies, local offices, and recognized portals—HowToGetAssistance.org is an informational resource only and cannot take appeals or applications.

By understanding your rights and the typical CHIP appeal process, you can take the next step confidently through your state’s official channels.