C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION › Subpart E—Fair Hearings for Applicants and Beneficiaries

42 C.F.R. § 431.200

Basis and scope

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This subpart—

(a) Implements section 1902(a)(3) of the Act, which requires that a State plan provide an opportunity for a fair hearing to any person whose claim for assistance is denied or not acted upon promptly;

(b) Prescribes procedures for an opportunity for a hearing if the State agency or non-emergency transportation PAHP (as defined in § 438.9(a) of this chapter) takes action, as stated in this subpart, to suspend, terminate, or reduce services, or of an adverse benefit determination by an MCO, PIHP or PAHP under subpart F of part 438 of this chapter; and

(c) Implements sections 1919(f)(3) and 1919(e)(7)(F) of the Act by providing an appeals process for any person who—

(1) Is subject to a proposed transfer or discharge from a nursing facility; or

(2) Is adversely affected by the pre-admission screening or the annual resident review that are required by section 1919(e)(7) of the Act.

(d) Implements section 1943(b)(3) of the Act and section 1413 of the Affordable Care Act to permit coordinated hearings and appeals among insurance affordability programs.

[67 FR 41094, June 14, 2002, as amended at 81 FR 27852, May 6, 2016; 81 FR 86448, Nov. 30, 2016]
Notes of Decisions
Cited in 66 cases (5 in the last 5 years), 1980–2026 · leading case: Prunckun v. Delaware Dept. of Health & Soc. Servs. Oldham v. Delaware Dept. of Health & Soc. Servs., 201 A.3d 525 (Del. 2019).
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Prunckun v. Delaware Dept. of Health & Soc. Servs. Oldham v. Delaware Dept. of Health & Soc. Servs., 201 A.3d 525 (Del. 2019). · cites it 4× “In support of her determination, the Hearing Officer cited to 42 C.F.R. § 431.200 (b), 42 C.F.R. § 431.”
Dunakin v. Quigley, 99 F. Supp. 3d 1297 (W.D. Wash. 2015). · cites it 5× “Dunakin alleges that Defendants violated Title XIX of the Social Security Act by failing to provide Medicaid benefits “with adequate written notice of [Defendants’ determinations, as well as the[ ] right to appeal to [Defendants’ administrative hearing process, pursuant to 42…”
Prado-Steiman Ex Rel. Prado v. Bush, 221 F.3d 1266 (11th Cir. 2000). · cites it 2× “§ 1396 (a)(3); see also 42 C.F.R. § 431.200 , et seq. Under the Home and Community Based Services Waiver Act, Title XIX of the Social Security Act, 42 U.”
Guggenberger ex rel. Guggenberger v. State, 198 F. Supp. 3d 973 (D. Minnesota 2016). “C, § 1396a(3), and corresponding regulations, 42 C.F.R. §§ 431.200 to 431.250. Defendants argue that Plaintiffs have failed to plead a viable Due Process claim.”
Ball v. Rodgers, 492 F.3d 1094 (9th Cir. 2007). “be provided to eligible persons”; (4) “the notice and hearing requirements" of the Fourteenth Amendment’s Due Process Clause; (5) the Medicaid Act’s “notice and fair hearing requirements,” § 1396a(a)(3); 42 C.F.R. §§ 431.200 et seq.; and (6) the "notice, grievance and hearing…”
Koenning v. Suehs, 897 F. Supp. 2d 528 (S.D. Tex. 2012). · cites it 3× “pdf (last visited Sept. 18, 2012). The Medicaid Act identifies the due process rights of Medicaid applicants and participants, including written notice and the opportunity for a fair hearing when assistance or services are denied.”
Easley v. Arkansas Dep't of Human Servs., 645 F. Supp. 1535 (E.D. Ark. 1986). · cites it 5× “Federal regulations require the agency to grant an opportunity for a hearing to: (1) Any applicant who requests it because his claim for services is denied or is not acted upon with reasonable promptness; and (2) Any recipient who requests it because he believes the agency has…”
Bruce Anderson v. Michael Wilkening, 930 F.3d 1066 (9th Cir. 2019). “See 42 C.F.R. § 431.200 (a), (c). 22 ANDERSON V.”
Bruner v. Timberlane Manor Ltd. P'ship, 2006 OK 90 (Okla. 2006). “The Medicaid appeal procedures at 42 C.F.R. § 431.200 et seq. apply to discharges or disputes of eligibility between the resident and the State Medicaid Agency and are not affected by a binding arbitration agreement.”
Catanzano v. Wing, 277 F.3d 99 (2d Cir. 2001). “The second clause of the class definition -- recipients "who have had their home health care suspended, denied, terminated or reduced without prior notice, right to a fair hearing and aid-continuing as mandated by 42 C.F.R. 431.200- 431.250," Catanzano II, 847 F.”
Cramer v. Chiles, 33 F. Supp. 2d 1342 (S.D. Fla. 1999). · cites it 2× “§ 1396a(a)(3); 42 C.F.R. § 431.200 , et seq. State officials, generally, must mail and give advance notice at least ten (10) days before the date of termination of or reduction in Medicaid benefits or services.”
Albert S. v. Dep't of Health & Mental Hygiene, 891 A.2d 402 (Md. Ct. Spec. App. 2006). · cites it 2× “42 C.F.R. §§ 431.200 (a) & 431.220(a)(1); COMAR 10.”
Show all 66 citing cases →
— 42 C.F.R. § 431.200(a) — 1 case
Shing v. Centers for Medicare & Medicaid Servs. (D. Maryland 2025).
— 42 C.F.R. § 431.200(b) — 2 cases
Prunckun v. Delaware Dept. of Health & Soc. Servs. Oldham v. Delaware Dept. of Health & Soc. Servs., 201 A.3d 525 (Del. 2019). “In support of her determination, the Hearing Officer cited to 42 C.F.R. § 431.200 (b), 42 C.F.R. § 431.”
Schreur v. Dep't of Human Servs., 795 N.W.2d 192 (Mich. Ct. App. 2010).
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