Medicaid Appeals

Each state has its own Medicaid program with different services covered. If you feel that your service or drug should be covered, talk with your doctor about appealing Medicaid’s decision.

Medicaid is a federal program run by each state. Some of the programs will be different from state to state. All state Medicaid programs currently have a prescription drug program as part of their services. The federal government has a list of drugs that states can include in their programs.

The Medicaid appeals process is different from those of private health insurance and the Medicare program. Almost all drugs are part of the Medicaid program. However, a few are not.

This website lists the drugs not covered (excluded) by Medicaid, by state. Click on your state and it will tell you what drugs are not covered.

Visit Medicaid Website

Since so many drugs are covered, if your drug is not on the list, it is unlikely an appeal will be approved. However, your doctor can appeal.
  • To start the appeal, call your doctor.
  • If you are at the pharmacy, they will need to call your doctor.

Each state has a different process. Your doctor usually needs to make the request. Your doctor will need to contact your state Medicaid office on how to appeal.