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Molina Healthcare — Denial Rates & Appeal Data

Name: Molina Healthcare prior authorization denial metrics
Creator: Coverage Rights

Medicare AdvantageMedicaid MCOMarketplace QHPReporting year 2025

Compare against every insurer we track: denial rates ranked within reporting cohorts.

Prior-auth denial rate

4.6%

of Medicare Advantage contracts requests denied

Appeal overturn rate

55.4%

of appealed Medicare Advantage contracts denials reversed

COVERAGE RIGHTS ROLLUP · CALCULATED FROM MOLINA HEALTHCARE PUBLIC DISCLOSURES

Molina posts per-plan reports across its state sites, percentages only (no request counts). Rates shown are enrollment-weighted averages of Molina's own posted per-contract Medicare Advantage figures across 15 contracts covering ~148K enrollees (weights: CMS Monthly Enrollment by Contract, July 2026; 6 further contracts lacked published enrollment). Molina republishes several multi-state contracts on more than one state page; those state views are averaged so each contract is weighted once by its national enrollment. Medicaid and marketplace plans are reported separately per state and are not included in this rollup.

UNDERLYING SOURCE: MOLINA HEALTHCARE CMS-0057-F DISCLOSURE, CY2025 · VIEW SOURCE ↗ · METHODOLOGY

Metrics by contract / plan

Molina Healthcare’s own CY2025 CMS-0057-F disclosures, plan by plan. Standard-request figures; every row links to its source.

Molina Healthcare CY2025 prior authorization metrics by contract or plan
Contract / plan	Line	Requests	Denied	Appeals overturned	Avg decision	Source
UT-URBAN-MEDICAID-NON-TRADITIONAL-NO-COPAY-NO-COINS · UT	Medicaid	n/r	50%	n/r	9d	Source
TX-CHIP-PERINATE-RSA-186-TO-200 · TX	Medicaid	n/r	33%	n/r	1d	Source
UT-HEALTHY-KIDS-PLAN-C · UT	Medicaid	n/r	28%	93%	7d	Source
SC-MEDICAID · SC	Medicaid	n/r	27%	18%	8d	Source
UT-HEALTHY-KIDS-PLAN-C-N · UT	Medicaid	n/r	25%	n/r	4d	Source
UT-URBAN-MEDICAID-TRADITIONAL-NO-COPAY-NO-COINS · UT	Medicaid	n/r	24%	77%	7d	Source
UT-URBAN-MEDICAID-TRADITIONAL-W-COPAY-NO-COINS · UT	Medicaid	n/r	20%	83%	6d	Source
UT-INTEGRATED-CARE-PLAN-TRADITIONAL · UT	Medicaid	n/r	19%	68%	6d	Source
UT-HEALTHY-KIDS-PLAN-B · UT	Medicaid	n/r	18%	67%	6d	Source
TX-STAR · TX	Medicaid	n/r	17%	54%	3d	Source
TX-CHIP · TX	Medicaid	n/r	17%	78%	3d	Source
MI-MEDICAID · MI	Medicaid	n/r	15%	50%	6d	Source
NM-TURQUOISE-CARE-PLAN · NM	Medicaid	n/r	15%	34%	4d	Source
TX-CHIP-RSA · TX	Medicaid	n/r	15%	76%	3d	Source
IL-MEDICAID · IL	Medicaid	n/r	14%	52%	2d	Source
H7559 · VA	Medicare Advantage	n/r	13%	43%	3d	Source
NY-MEDICAID-MLTSS · NY	Medicaid	n/r	13%	16%	3d	Source
NE-MEDICAID · NE	Medicaid	n/r	13%	37%	4d	Source
TX-MARKETPLACE · TX	Marketplace	n/r	13%	50%	5d	Source
FL-MARKETPLACE · FL	Marketplace	n/r	13%	50%	5d	Source
MI-MARKETPLACE · MI	Marketplace	n/r	13%	50%	5d	Source
MS-MARKETPLACE · MS	Marketplace	n/r	13%	50%	5d	Source
OH-MARKETPLACE · OH	Marketplace	n/r	13%	50%	5d	Source
SC-MARKETPLACE · SC	Marketplace	n/r	13%	50%	5d	Source
UT-MARKETPLACE · UT	Marketplace	n/r	13%	50%	5d	Source
WI-MARKETPLACE · WI	Marketplace	n/r	13%	50%	5d	Source
H7678 · TX	Medicare Advantage	n/r	11%	53%	3d	Source
H8046 · IL	Medicare Advantage	n/r	10%	49%	1d	Source
H8197 · TX	Medicare Advantage	n/r	10%	44%	2d	Source
WI-MEDICAID-BADGERCARE-PLUS · WI	Medicaid	n/r	10%	63%	5d	Source
H5280 · OH	Medicare Advantage	n/r	9%	40%	3d	Source
H2533 · SC	Medicare Advantage	n/r	9%	56%	3d	Source
H5628 · UT	Medicare Advantage	n/r	9%	69%	3d	Source
H1799 · KY	Medicare Advantage	n/r	9%	46%	2d	Source
AZ-MEDICAID · AZ	Medicaid	n/r	9%	53%	6d	Source
H8845 · NM	Medicare Advantage	n/r	8%	33%	3d	Source
H5992 · NY	Medicare Advantage	n/r	8%	30%	2d	Source
NE-CHIP · NE	Medicaid	n/r	8%	33%	4d	Source
VA-CARDINAL-CARE · VA	Medicaid	n/r	8%	16%	6d	Source
H5926 · MI	Medicare Advantage	n/r	7%	56%	1d	Source
H9955 · OH	Medicare Advantage	n/r	7%	53%	2d	Source
H5823 · WA	Medicare Advantage	n/r	7%	65%	3d	Source
WI-MEDICAID-SSI · WI	Medicaid	n/r	7%	57%	6d	Source
MS-MEDICAID · MS	Medicaid	n/r	7%	58%	2d	Source
H5628 · ID	Medicare Advantage	n/r	6%	65%	2d	Source
H8176 · SC	Medicare Advantage	n/r	6%	75%	2d	Source
H2715 · TX	Medicare Advantage	n/r	6%	n/r	2d	Source
H2224 · MA	Medicare Advantage	n/r	6%	49%	2d	Source
TX-STAR-PLUS · TX	Medicaid	n/r	6%	65%	3d	Source
H8845 · AZ	Medicare Advantage	n/r	5%	100%	2d	Source
H2715 · IL	Medicare Advantage	n/r	5%	67%	4d	Source
H2715 · NE	Medicare Advantage	n/r	5%	50%	2d	Source
H2478 · NV	Medicare Advantage	n/r	5%	0%	2d	Source
TX-CHIP-PERINATE-RSA-AT-OR-BELOW-185 · TX	Medicaid	n/r	5%	100%	2d	Source
TX-CHIP-PERINATE-MHT-AT-OR-BELOW-185 · TX	Medicaid	n/r	4%	n/r	1d	Source
ID-MEDICAID-PLUS · ID	Medicaid	n/r	4%	80%	1d	Source
IA-MEDICAID · IA	Medicaid	n/r	4%	65%	3d	Source
H7844 · MI	Medicare Advantage	n/r	3%	53%	2d	Source
H5810 · CA	Medicare Advantage	n/r	2%	81%	2d	Source
H3038 · CA	Medicare Advantage	n/r	2%	52%	2d	Source
CA-MEDICAID · CA	Medicaid	n/r	2%	43%	2d	Source
H5649 · CA	Medicare Advantage	n/r	1%	50%	2d	Source
H8845 · MS	Medicare Advantage	n/r	0%	n/r	0d	Source
NY-FIDE · NY	Medicaid	n/r	0%	n/r	5d	Source
TX-CHIP-PERINATE-MHT-186-TO-200 · TX	Medicaid	n/r	0%	n/r	3d	Source
UT-INTEGRATED-CARE-PLAN-NON-TRADITIONAL · UT	Medicaid	n/r	0%	n/r	10d	Source

N/R = NOT REPORTED · COLLECTED 2026-07-19 FROM MOLINA HEALTHCARE’S PUBLISHED DISCLOSURES

What these numbers mean for your denial

Coverage Rights calculated a 4.6% prior-authorization denial rate for the Medicare Advantage contracts in 2025. In the calculated Medicare Advantage contracts appeal scope, 55.4% were reversed — most denials that got challenged did not survive review. The underlying contract or plan figures were published by Molina Healthcare; Coverage Rights performed the stated rollup.

The practical takeaway is narrower: an initial denial can change on review. These aggregate rates describe past decisions within the stated reporting scope; they do not predict the result of an individual appeal.

Your appeal deadline depends on your plan type

Molina Healthcare runs several kinds of plans, and the appeal rules follow the plan, not the insurer. Find the ladder and the deadlines for yours:

Medicare Advantage appeal rights Medicaid appeal rights ACA / Marketplace appeal rights

Common questions

What is Molina Healthcare's prior authorization denial rate?

Coverage Rights calculated a 4.6% prior-authorization denial rate for the Medicare Advantage contracts reporting scope in 2025, using the public disclosure required by federal rule CMS-0057-F. Within the calculated Medicare Advantage contracts appeal scope, 55.4% were overturned.

How do I appeal a Molina Healthcare denial?

Start with the appeal instructions in Molina Healthcare's denial notice. An independent external, fair-hearing, or Medicare review may be available after the required internal review, but eligibility depends on the coverage program, plan funding, denial type, regulating jurisdiction, and whether the notice says internal review is exhausted. Use the pathway tool before choosing the next reviewer.

Where do these numbers come from?

Coverage Rights calculated the displayed rollup from Molina Healthcare's public CMS-0057-F disclosures for 2025. The methodology note identifies the included reporting scope and weighting or aggregation method; source links lead to the underlying insurer-published records.

Denied by Molina Healthcare? 55.4% were overturned in the Coverage Rights rollup of the Medicare Advantage contracts scope. Build an evidence-backed appeal.

How to appeal Start my appeal