Epilepsy is diagnosed when an individual has two or more unprovoked seizures more than 24 hours apart. However, previous research has suggested that some individuals have multiple seizures prior to their first recognized or recorded index seizure and there may be substantial delay between the onset of seizures and an epilepsy diagnosis. A longer time between seizure onset and epilepsy diagnosis may lead to delays in treatment and poor outcomes. This study characterized time delays between first and second seizures and epilepsy diagnosis in a large cohort of Medicaid beneficiaries and assessed demographic variables that may be associated with a delayed epilepsy diagnosis. Given known racial disparities in epilepsy care, we were particularly interested in time to diagnosis among racial and ethnic minorities.