To file a Medi-Cal appeal, you request a state hearing from the California Department of Social Services. The process is free, you can file by phone, online, by mail, or by fax, and the state must schedule your hearing within 30 working days of receiving the request and issue a final decision within 90 days.1Justia. California Welfare and Institutions Code 10950-10967 – Hearings2eCFR. 42 CFR 431.244 Your deadline depends on how you receive your Medi-Cal, so start there.
Find the Deadline That Applies to You
Any time the county welfare office or the Department of Health Care Services denies, discontinues, or reduces your benefits, or changes your share of cost, they must send you a written Notice of Action explaining what changed and why.3New York Codes, Rules and Regulations. 22 CCR 50179 – Notice of Action — Medi-Cal-Only Determinations or Redeterminations Hold on to that notice. You will need the case number, mail date, and the specific action it describes to file.
For fee-for-service Medi-Cal (decisions made directly by the county), you have 90 days from the date of the action or notice to request a state hearing.4Justia. California Welfare and Institutions Code 10950-10967 – Hearings – Section 10951 If you miss that window, you can still file up to 180 days later if you show “good cause” — a substantial reason beyond your control that prevented timely filing. The director decides whether your reason qualifies.
If you get Medi-Cal through a managed care health plan, the rules are different. You generally must file an internal appeal with the plan first, within 60 calendar days of the plan’s notice of action.5California Department of Social Services. State Hearing Requests Once the plan issues its Notice of Appeal Resolution, you have 120 calendar days from that resolution to request a state hearing if you still disagree. If the plan does not resolve your appeal within 30 days, you can skip the wait and go straight to the state hearing process.
Four Ways to File Your Request
You do not need a specific form. California accepts hearing requests in any written format, including a plain letter, but filing through one of these channels makes sure the request reaches the State Hearings Division:
- Phone: Call the State Hearings Division toll-free at (800) 743-8525. You can request both standard and expedited hearings this way.5California Department of Social Services. State Hearing Requests
- Online: Use the Appeals Case Management System (ACMS) on the CDSS website. ACMS also lets you upload documents and track your case.6California Department of Social Services. Appeals Case Management System
- Mail: Send your request to the State Hearings Division, PO Box 944243, MS 21-37, Sacramento, CA 94244-2430. Certified mail with a return receipt gives you proof of your filing date.7California Department of Social Services. State Hearings
- Fax: Fax to (833) 281-0905 and save the confirmation page.7California Department of Social Services. State Hearings
Many Notices of Action have a hearing request form printed on the back. You can tear it off, fill it out, and send it in. County welfare offices also keep blank forms for people who prefer to file in person.
What to Put in Your Request
Whether you use a form or write a letter, include your full name, the case number from the Notice of Action, the specific action you are contesting (denial, reduction, discontinuance, share-of-cost change), and a short explanation of why you believe the decision is wrong. Plain language works. If the county used the wrong income figure, miscounted your household, or ignored documents you sent in, say so and name the specific dates or amounts you dispute.
The request form also has fields for your practical needs at the hearing. You can ask for a professional interpreter in any language at no cost, or request disability accommodations like American Sign Language services or large-print documents. Filling these in now prevents scheduling delays later.
Keep Your Current Benefits Running (Aid Paid Pending)
If the county is reducing or terminating benefits you already receive, you can keep them at their current level while your hearing is pending. Timing is the whole game. You must request the hearing before the effective date of the action listed on the Notice of Action, and check the “aid paid pending” box on your request. Federal rules require the notice to go out at least 10 days before the action takes effect, so that 10-day window is your opportunity.8National Health Law Program. Recoupment Following an Adverse Medicaid Appeal
If you depend on ongoing care — prescriptions, home health services, mental health treatment — losing coverage for the weeks or months before your hearing can cause real harm, and this is how you prevent that gap. One caution: if you ultimately lose, the state can seek to recover the cost of benefits paid during the appeal.
Get Help If You Need It
You can appoint someone else to handle the appeal for you — a family member, friend, social worker, or attorney — by completing DHCS Form MC 382, the authorized representative form.9Department of Health Care Services. MC 382 – Authorized Representative Your representative can file the request, submit evidence, and attend the hearing in your place. Return the completed MC 382 to your local county office by mail, in person, by phone, or electronically.
If you have an urgent health condition that could cause serious harm without prompt treatment, request an expedited hearing. The fastest way is to call the State Hearings Division at (800) 743-8525.5California Department of Social Services. State Hearing Requests10Medicaid.gov. Understanding Medicaid Fair Hearings Your Notice of Action should include instructions for expedited requests tied to your specific situation.
What to Expect After You File
The State Hearings Division sends a written acknowledgment with a case number and assigns an Administrative Law Judge. The hearing must be scheduled to begin within 30 working days of your filing date, and you get at least 10 days’ written notice of the date, time, and location.11Justia. California Welfare and Institutions Code 10950-10967 – Hearings – Section 10952 Hearings may be held in person, by phone, or by videoconference.10Medicaid.gov. Understanding Medicaid Fair Hearings If the format creates a hardship, contact the division to request a change.
The hearing itself is informal. There are no courtroom rules of evidence, though testimony is given under oath.12Justia. California Welfare and Institutions Code 10950-10967 – Hearings – Section 10955 Bring what supports your case: pay stubs or bank statements if income is in dispute, medical records or a letter from your doctor if the issue involves treatment or eligibility, and copies of anything you previously submitted that the county says it never received. Bring extras for the judge and the county representative, plus the Notice of Action.
Who has to prove what depends on your situation. If you are applying for the first time, you have to show you qualify. If the county is cutting or ending benefits you already have, the county generally has to justify the change. If it cannot clearly explain the cut, the judge should rule in your favor.
After the hearing, the judge issues a proposed decision. The Director of the Department of Social Services then has 30 days to adopt, modify, or order a new hearing on it. If the director does nothing in those 30 days, the proposed decision automatically becomes final.13Justia. California Welfare and Institutions Code 10950-10967 – Hearings – Section 10959 The whole process, from filing to final decision, must finish within 90 days under federal law.2eCFR. 42 CFR 431.244 If you win, the county must restore or adjust your benefits as ordered.
If You Lose
You have 30 days from the final decision to request a rehearing from the director. The request doesn’t need a specific format, but it must explain why the decision was wrong — new evidence the judge didn’t consider, a legal error, or a factual mistake.14California Department of Social Services. Rehearing Review Protocols A late request may still work if you show good cause, but no rehearing will be granted more than 180 days after the original action.
If the rehearing is denied or you lose again, the next step is Superior Court. You file a petition for a writ of administrative mandate under Code of Civil Procedure Section 1094.5, and the court reviews whether the agency followed proper procedure, whether the decision is supported by the evidence, and whether the agency abused its discretion.14California Department of Social Services. Rehearing Review Protocols Court filings carry fees and procedural requirements, so talk to a legal aid organization before you go that route.