Medicaid; eligibility determination appeal time limit, mailed communications time period.

Plain English Breakdown

The official source does not specify the exact number of days for appeal extensions beyond mentioning 'mailing delays as good cause'.

Medicaid Appeal Time Limit Extension

This bill changes the rules for how long people can appeal Medicaid eligibility decisions and sets a time period for mailed communications about Medicaid, SNAP, and TANF.

What This Bill Does

• Extends the time limit for filing appeals of Medicaid eligibility determinations to 75 days from when the notice is sent.
• Allows the Department of Medical Assistance Services to consider mailing delays as good cause for late appeal filings.
• Requires both the Department of Medical Assistance Services and the Department of Social Services to review their current practices for sending notices about benefits like Medicaid, SNAP, and TANF.

Who It Names or Affects

• People who apply for or receive Medicaid benefits
• The Department of Medical Assistance Services
• The Department of Social Services

Terms To Know

Medicaid

A government program that helps people with low income pay for medical care.

SNAP

Supplemental Nutrition Assistance Program, which provides food assistance to eligible individuals and families.

TANF

Temporary Assistance to Needy Families, a program that helps low-income families with children meet their basic needs.

Limits and Unknowns

• The bill does not specify how long the mailing time period for communications should be.
• It is unclear if there are any specific changes to provider appeals or managed care organizations' appeal processes.

Official Summary Text

Department of Medical Assistance Services; Department of Social Services; Medicaid eligibility determination appeal time limit; mailed communications time period.
Directs (i) the Department of Medical Assistance Services to amend its regulations to extend the time limit for appeals of eligibility determinations and (ii) the Department of Medical Assistance Services and the Department of Social Services to amend their regulations to create a mailing time period for communications related to Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance to Needy Families (TANF).

Current Bill Text

HOUSE BILL NO. 1240

AMENDMENT IN THE NATURE OF A SUBSTITUTE

(Proposed by the House Committee on Health and Human Services

on February 3, 2026)

(Patron Prior to Substitute--Delegate Willett)

A BILL to direct the Department of Medical Assistance Services to amend its regulations to extend the time limit for appeals of eligibility determinations and to direct the Department of Medical Assistance Services and the Department of Social Services to review current notice practices to ensure that applicants for and recipients of medical assistance or social services benefits are aware of available assistance.

Be it enacted by the General Assembly of Virginia:

1.
§ 1.
The Department of Medical Assistance Services
(the Department)
shall
extend the time limit for filing a
r
equest for
a Medicaid eligibility

a
ppeal
to 90 days within
issuance of
the notice of an action or adverse determination.
The Department shall
consider mailing delays as good cause for late filing of appeals
.

The Department shall have the authority to implement these changes prior to the completion of any regulatory process and shall amend the state plan as necessary to implement these changes.

Nothing in this act shall be construed to affect provider appeals or the timeframe to appeal actions by Medicaid managed care organizations.

The Department
shall
, in collaboration with the Department of Social Services, review current notice
practices
to ensure that applicants
for
and
recipients of medical assistance
or
social services
benefits
are aware of
(i)
assistance
available to applicants and
recipients
for verifying information and (ii)
how to contact the appropriate person
if
an applicant or recipient
receive
s
information after a due date or
experiences
difficulty securing verifications.
Entities responsible for receiving and processing mail
related to the administration of medical assistance or social services benefits
shall practice using existing good cause policies to grant extensions and to reinstate application
s
or case
s
for review as applicable.