Medicaid filing limits: 21 states publish one, 30 do not

What we set out to do, and what happened

A Medicaid claim filed past its deadline is not late, it is unpayable — no appeal recovers it and no amount of follow-up brings it back. So the deadline is arguably the single most consequential number in a practice’s billing, and it differs by state. Texas allows 95 days from the date of service. Ohio allows 365. The same claim, filed the same way on the same day, is four months early in one state and permanently dead in the other.

We needed those numbers for a tool, so we went looking for all fifty-one. The rule we set before starting was that a figure would only be published if we could read it in the state’s own regulation and quote the sentence. Not a billing company’s blog post, not a summary, not a figure repeated across a dozen sites with no source. The regulation, with the citation.

Twenty-one states met that standard. Thirty did not.

The twenty-one we could quote

Sorted by how long they give you. Massachusetts, New Mexico and New York allow 90 days. Texas allows 95. Arizona, Illinois, Indiana, Oklahoma and Pennsylvania allow 180. Alabama, Iowa, Kentucky, Maryland, Mississippi, Missouri, New Jersey, North Carolina, Ohio, Tennessee and Washington allow 365. California’s rule could be sourced but is not a simple day count, so no single figure can honestly be quoted for it.

The spread is the point. A practice operating in two states is working two different clocks with a four-fold difference between them, and a worklist that treats them the same is quietly writing off claims in the shorter one.

The thirty we could not, and what that actually means

Alaska, Arkansas, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Kansas, Louisiana, Maine, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, North Dakota, Oregon, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Virginia, West Virginia, Wisconsin and Wyoming.

This is not a claim that those states have no filing limit. Every one of them does, and the federal floor requires claims within twelve months of the date of service — a state may set a shorter window but not a longer one. What it means is narrower and more useful: we could not find the figure stated in a regulation we could cite. In several cases the rule lives in a provider manual rather than in the administrative code, in some it is set per managed-care plan rather than by the state, and in others the document we found was undated or contradicted another page on the same site.

That is worth writing down because the alternative is what the rest of the internet does: repeat a number, uncited, until it looks settled. A practice that escalates on an uncited deadline and turns out to be wrong has spent credibility it will need again.

How to get your own figure, in writing

Ask your state Medicaid agency or your managed-care representative for the filing limit and the citation, by email, and keep the reply. It is a two-line request and the written answer is worth more than any table on any website, including this one. If the answer names a provider manual, get the version and the date — manuals are revised and the revision is where the argument goes.

Then check whether it runs from the date of service or the date of discharge, whether inpatient differs, and what the resubmission window is after a denial. Those three questions change the practical deadline more often than the headline number does.

The method, so you can check us

Each figure we publish carries the regulation, the section and the sentence it came from, retrieved on a stated date. Where a state’s rule is not expressible as a day count we say so rather than picking the nearest number. Where we could not source it we list the state as unsourced rather than filling the gap with the federal floor, because presenting a federal minimum as a state rule is how a wrong deadline enters somebody’s workflow.

If you hold a citable regulation for one of the thirty, send it to ops@softhomeglobal.com and we will add it with the credit. That is a genuine request — the list is shorter than it should be.