Answer
Can you keep getting the drug while your appeal is decided?
The short answer
In Medicaid, often yes — but only if the state is ending something you already had, and only if you file before the change takes effect. That is a far shorter clock than your appeal deadline.
What the federal rule actually provides
There is a mechanism, it is old, and it is narrower than most people assume. Where a state sends the advance notice the rules require and the beneficiary asks for a hearing before the date of action, the agency may not stop or cut the service until the hearing has been decided.
Read that sentence for what it does not say. It does not say the drug keeps coming while any appeal runs. It applies where something is being ended or reduced, not where a first request was refused — you cannot continue a benefit you were never receiving. And it hangs on filing before the change takes effect rather than merely within the general filing window.
Why the two clocks get confused
The appeal deadline and the continuation deadline are different deadlines, and the gap between them is where people lose this. Federal rules cap the hearing request at 90 days from the mailing date; the continuation clock can be ten days, and it runs to the effective date of the change rather than to a fixed count.
So it is entirely possible to file a perfectly timely appeal and still have the drug stop, because the shorter clock ran out first. Nobody sends a second letter to point that out. If your notice says a benefit ends on a date, that date is the one to work backwards from.
What it can cost you
The regulation attaches a consequence and states it plainly: if the hearing goes against you, the agency may start recovery procedures to recoup the cost of what it paid while the case was pending, to the extent those services were furnished only because of this rule.
Whether a state actually pursues that is a state-by-state question we have not researched, and this page does not guess at it. That it is permitted is federal, and it is the trade-off to be aware of before choosing.
Where the states we have read set their own window
The federal rule sets the shape; states fill in the number, and the numbers are short. Two of the states on this site publish one in a document we have read, and both landed in the same place. California publishes a continuation window too, in the letter it mailed to members — that one is on its own page, dated to the month we read it, rather than restated here.
The pattern to take from this is not the number itself but its size relative to the appeal window. A state can give you thirty or ninety days to appeal and ten days to keep the drug, and both are in the same notice.
What this does not cover
Commercial and employer plans do not work this way. The continuation rule above is Medicaid, and a commercial plan's obligation to keep paying during an internal appeal is a matter of the plan document rather than of this regulation. Medicare Part D has its own separate structure.
We have also not researched, for every state, whether a managed care plan's internal appeal carries its own continuation window on top of the state's. Where a state page here says the plan appeal comes first, assume that question is open until the plan's own notice answers it.
What to say on the phone
I received a notice dated [date] saying my [drug name] coverage will end on [effective date]. I am requesting a fair hearing, and I am also requesting that my benefits continue unchanged while the hearing is pending. Please confirm in writing that you have recorded both requests, and confirm the date by which the continuation request must be received.
Ask for the continuation in the same breath as the hearing, and get the date confirmed. The two requests have different deadlines and only one of them is on the front of most notices.
Every claim above, with the document behind it
If something here decides anything for you, read the source rather than our summary of it. These are the documents we opened, and the month we opened them.
Filing before the change takes effect is what holds the benefit in place: "If the agency sends the 10-day or 5-day notice as required under § 431.211 or § 431.214 of this subpart, and the beneficiary requests a hearing before the date of action, the agency may not terminate or reduce services until a decision is rendered after the hearing" — subject to a narrow exception where the hearing finds the sole issue is one of federal or state law or policy.
42 CFR §431.230(a), Electronic Code of Federal Regulations, effective August 2026 · source
Losing can carry a bill. "If the agency’s action is sustained by the hearing decision, the agency may institute recovery procedures against the applicant or beneficiary to recoup the cost of any services furnished the beneficiary, to the extent they were furnished solely by reason of this section."
42 CFR §431.230(b), Electronic Code of Federal Regulations, effective August 2026 · source
The appeal clock is the long one, and it is a ceiling rather than a target: the agency "must allow the applicant or beneficiary a reasonable time, not to exceed 90 days from the date that notice of action is mailed, to request a hearings." The wording, including the typographical error, is the regulation’s own. This is the deadline the continuation window sits inside, not the deadline that protects the benefit.
42 CFR §431.221(d), Electronic Code of Federal Regulations, effective August 2026 · source
The state's hearing window is thirty days and it runs from a postmark. Title 23 Part 300, Rule 2.8, states: "The applicant or beneficiary has thirty (30) days from the postmark date of the appropriate notice to request either a local or state hearing. This thirty (30) day filing period may be extended if the applicant or beneficiary can show good cause, as determined by the Division of Medicaid, for not filing within thirty (30) days." Keeping a benefit running is a separate and shorter clock: Rule 2.21 requires the continuation request to reach the regional office "within ten (10) days from the notice date of the adverse action," and warns the division may recover the cost of services furnished solely under that provision. For managed care members, Rule 1.2 states that beneficiaries and providers "must exhaust all appeals with the coordinated care organizations (CCOs) prior to requesting a fair and/or administrative hearing with the Division of Medicaid."
Mississippi Administrative Code Title 23, Part 300 (Appeals), Mississippi Division of Medicaid, effective March 2023 · source
Missouri publishes two different appeal clocks and which one applies turns on what the state did. Where it is refusing a request, the statute gives "ninety days from the date of the notice of the action in which to request an appeal to the director of the division." Where it is cutting something already in place, the window is much shorter and carries a benefit with it: the recipient "shall have ten days from the date of the mailing of notice of the proposed action... within which to request an appeal," and "If an appeal is requested, benefits or services shall continue undiminished or unchanged until such appeal is heard and a decision has been rendered thereon." The statute adds that an appeal filed in the ninety-day period after a closing or modification does not carry continued benefits.
Section 208.080, Revised Statutes of Missouri, Missouri Revisor of Statutes, effective August 2014 · source
Where this comes from
- 42 CFR §431.230(a), Electronic Code of Federal Regulations, effective August 2026 — www.ecfr.gov/current/title-42/part-431/section-431.230
- 42 CFR §431.221(d), Electronic Code of Federal Regulations, effective August 2026 — www.ecfr.gov/current/title-42/part-431/section-431.221
- Mississippi Administrative Code Title 23, Part 300 (Appeals), Mississippi Division of Medicaid, effective March 2023 — medicaid.ms.gov/wp-content/uploads/2025/07/Title-23-Part-300-Appeals-eff
- Section 208.080, Revised Statutes of Missouri, Missouri Revisor of Statutes, effective August 2014 — revisor.mo.gov/main/OneSection.aspx?section=208.080
Where to go next
- Continuation of benefits, defined from the regulation
- Notice of action: the letter that starts your clock
- How to ask for a Medicaid fair hearing
- Count your filing dates from the date on your notice
- What your own state publishes
- Every question we have answered
American GLP is not a law firm, an insurer, a government office or a clinician, and nothing here is legal or medical advice. This page describes what published rules say. Your own plan documents and your own notice govern your case, and rules change — check the sources before you act.