Your CHIP Adverse Action Notice, Explained
Also called: CHIP adverse action notice, CHIP notice of denial, CHIP notice of termination
Last reviewed 2026-07-18
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What this notice usually means
A CHIP adverse action notice tells a family that a state plans to change a child's CHIP case. This can mean a denial. It can mean a cut in coverage. It can mean the state plans to end coverage. Federal rule says the state must offer a review. This applies to a denial of eligibility. It applies to a slow decision too. It applies to a suspension or an end of coverage. Your notice must state the reason for the action. It must explain your right to review. It must explain how standard and fast review work. It must explain how to ask for a review. It must say when coverage can continue while a review is pending. Your state CHIP agency decides your child's case. It also decides the outcome of any review.
See every source line for this notice
“A State must ensure that an applicant or enrollee has an opportunity for review, consistent with §§ 457.1140 and 457.1150, of a—”
“Denial of eligibility; (2) Failure to make a timely determination of eligibility; and (3) Suspension or termination of enrollment, including disenrollment for failure to pay cost sharing.”
“A State must provide enrollees and applicants timely written notice of any determinations required to be subject to review under § 457.1130 that includes the reasons for the determination, an explanation of applicable rights to review of that determination, the standard and expedited time frames for review, the manner in which a review can be requested, and the circumstances under which enrollment and benefits may continue pending review.”
“A State must ensure the opportunity for continuation of enrollment and benefits pending the completion of review of the following: (a) A suspension or termination of enrollment, including a decision to disenroll for failure to pay cost sharing; and (b) A failure to make a timely determination of eligibility at application and renewal.”
“Review decisions are written; and (d) Applicants and enrollees have an opportunity to— (1) Represent themselves or have representatives of their choosing in the review process;”
What to do now
- 1
Read the reason on your notice
Federal rule says your notice must state the reason for the state's choice. Compare that reason to your own records. Then decide what to do next.
- 2
Find your review deadline on the notice
Federal rule says the notice must explain how to ask for a review. It must list the standard and fast time frames. The exact number of days differs by state. Use the date on your own letter.
- 3
Ask about continued coverage during review
Federal rule says states must explain when coverage can continue during a review. Ask your state CHIP agency about this. Do it before any coverage gap starts.
- 4
Know the state's own clock
For a health service, like a denied service, the state must finish review in 90 days. It has 72 hours if a delay could harm your child's health. Eligibility and enrollment reviews must finish in a reasonable time.
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Deadline
For a health service decision, like a denied or reduced service, the state must finish an outside review in 90 days. It has 72 hours if a delay could seriously harm your child's health. For a denial or an end of eligibility itself, federal rule sets no single number of days. It just says review must happen in a reasonable time. Your own notice has the real deadline to ask for a review in your state.
“A State must complete the review of a matter described in § 457.1130(a) within a reasonable amount of time. In setting time frames, the State must consider the need for expedited review when there is an immediate need for health services.”
“A State must ensure that external review, as described in § 457.1150(b), is completed within 90 calendar days of the date an enrollee requests internal (if available) or external review.”
“A State must ensure that external review, as described in § 457.1150(b), is completed within 72 hours of the time an enrollee requests external review, if the enrollee's physician or health plan determines that operating under the standard time frame could seriously jeopardize the enrollee's life or health or ability to attain, maintain or regain maximum function.”
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Sources
- Electronic Code of Federal Regulations (eCFR), 42 CFR 457.1130Retrieved 2026-07-17
- Electronic Code of Federal Regulations (eCFR), 42 CFR 457.1140Retrieved 2026-07-17
- Electronic Code of Federal Regulations (eCFR), 42 CFR 457.1160Retrieved 2026-07-17
- Electronic Code of Federal Regulations (eCFR), 42 CFR 457.1170Retrieved 2026-07-17
- Electronic Code of Federal Regulations (eCFR), 42 CFR 457.1180Retrieved 2026-07-17
Last reviewed 2026-07-18
Related notices
Related words
Adverse action
An adverse action is any time an agency stops, lowers, or suspends your benefits. It gives you the right to advance notice and an appeal.
Notice of action
A notice of action means an agency's official letter about a decision on your case. It states what the agency decided, why, and how to appeal.
Fair hearing
A fair hearing is a meeting where you can challenge a state decision to deny, reduce, or stop your benefits. Someone who did not make the first decision listens to your side.
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