Your D-SNP or MAP plan denied a service in New York: how to appeal, step by step

In short: start by appealing to the plan. For a Medicaid Advantage Plus (MAP) plan, you file one "integrated" appeal with the plan within 60 days of the denial notice. If you lose, Medicare-covered services go automatically to an independent reviewer, and for Medicaid-covered services (like home care hours) you can ask for a State Fair Hearing within 120 days. For other Medicare Advantage plans, including most D-SNPs, you have 65 days to appeal to the plan. Ask for a fast appeal if waiting could harm your health.

Last checked September 28, 2026, against the Department of Health's MAP appeals materials for 2026, the federal rule at 42 CFR 422.633, and Medicare.gov.

First: which kind of plan are you in?

Your member card and your plan's Evidence of Coverage name the plan type. If you are not sure, our what is a D-SNP guide explains the difference.

Step by step: MAP plan appeals in 2026

Since January 1, 2026, MAP plans follow the federal unified appeals rules (42 CFR 422.629–634), according to the Department of Health.

1. Read the denial notice. It must say what was denied, why, and how to appeal.
2. File a Level 1 appeal with the plan within 60 days of when you received the notice. The rule presumes you got it 5 days after the date on it. You can ask by phone or in writing.
3. Ask for aid continuing if services are being cut. To keep services during the appeal, file within 10 days of the notice or by the date the change takes effect, whichever is later.
4. Ask for a fast appeal if waiting could seriously harm your health. The plan must decide a standard appeal within 30 days and a fast one within 72 hours. It can extend either by up to 14 days.
5. If the plan says no (or partly no):

• Medicare-covered service: the plan automatically sends your case to the Independent Review Entity (MAXIMUS). You do not file anything.
• Medicaid-covered service (for example, home care hours): request a State Fair Hearing within 120 days of the plan's decision. For aid continuing, ask within 10 days of the Level 1 decision or by its effective date, whichever is later.
• Covered by both: the case goes to the IRE automatically, and you can also request a Fair Hearing.
• External Appeal: for denials based on medical necessity, you can also ask for a New York State External Appeal within 4 months. If you file both, the Fair Hearing decision is the one that counts.

Step by step: other D-SNPs and Medicare Advantage plans

1. Appeal to the plan within 65 days of the denial notice. Special Needs Plans must tell you in writing how to appeal.
2. Plan deadlines (Medicare.gov): 30 days for a service you have not received yet, 60 days for a payment request, 7 days for a Part B drug. A fast appeal is decided within 72 hours.
3. If the plan still says no, it automatically sends your case to an independent reviewer.
4. Further levels: in 2026, an Administrative Law Judge hearing requires at least $200 in dispute, and federal court requires at least $1,960.
5. For Medicaid services your D-SNP does not cover, the Medicaid side has its own notice and appeal rights. Follow that notice.

What to gather

• The denial notice and the envelope, so you can prove the date you got it.
• A letter from your doctor explaining why you need the service.
• Your plan of care or recent assessment, if it is about home care.
• Notes of every call: date, time, name, and what they said.
• Copies of anything you send. Keep the originals.

Free help

ICAN (Independent Consumer Advocacy Network) is New York's free ombudsman program for people in Medicaid long-term care and integrated plans. Call 1-844-614-8800 (TTY 711) or visit icannys.org.

Common mistakes

• Waiting for a callback before filing. The clock runs from when you got the notice.
• Asking for a Fair Hearing first, before the plan appeal. For MAP, the plan appeal comes first.
• Missing the 10-day window when you want services to continue during the appeal.
• Not asking for a fast appeal when your health is at risk.
• Filing by phone without writing down the date and the name of the person.

Want help with this? Get free one-on-one guidance.

If your plan denied a service and you want help sorting out which appeal applies, start with our short form. At the end you can ask for free one-on-one guidance. It is optional, and appeals are decided by the plan, the state, or Medicare.