Medi-Cal Notice of Action: Appeals, Deadlines, and Hearings

A Medi-Cal Notice of Action is the official letter your county or the California Department of Health Care Services sends whenever it makes a decision that affects your coverage: approving you, denying you, adjusting your benefits, changing your share of cost, or ending your Medi-Cal entirely.¹ If the decision cuts or ends your benefits and you disagree, you have 90 days to request a state hearing, and you can keep your current coverage running during the appeal if you file quickly enough. Two dates on the notice control everything: the mailing date and the effective date. Read them before you do anything else.

What the Notice Actually Says

Every Notice of Action includes your name, case number, and the contact information for the eligibility worker handling your case. It states the specific action the county is taking and the date the change takes effect. It should also explain the eligibility decision clearly enough that you can tell why it was made.²

The notice cites the legal authority behind the decision, usually California Code of Regulations Title 22, Section 50179, which requires counties to notify you in writing of your eligibility or ineligibility and any changes to your share of cost.¹ On the back you’ll find your hearing rights and, in most cases, instructions for requesting a state hearing.

Why You Might Have Gotten One

Notices of Action cover the full life of a Medi-Cal case. The common triggers:

Initial approval or denial of your application. A denial should say which requirement you didn’t meet.
Changes in income or household size that cause the county to recalculate your eligibility.
Share of cost adjustments — the monthly amount you pay toward medical expenses before Medi-Cal pays.
Annual redetermination, when the county reviews your case and finds you no longer qualify or your benefits should change.
Discontinuance, meaning your coverage is ending entirely.

Not every notice is correct. County workers handle heavy caseloads, and calculation errors are common. Frequent mistakes include failing to adjust your share of cost after Social Security’s annual cost-of-living increase, miscounting household income, and not verifying asset values before issuing a discontinuance. If the numbers on your notice don’t match your actual situation, gather your pay stubs, bank statements, and benefit letters before you respond.

The 2026 Asset Limit Change

Starting January 1, 2026, California reinstated asset limits for many Medi-Cal programs. For non-expansion Medi-Cal, countable assets cannot exceed $130,000 for an individual, with $65,000 added for each additional household member.³ This affects Aged, Blind, and Disabled Medi-Cal, the Medically Needy program, the 250% Working Disabled Program, long-term care, and Medicare Savings Programs. Adults and children in Medi-Cal expansion categories are exempt from the asset test. People with SSI-linked Medi-Cal remain subject to the separate SSI resource limit of $2,000.

Many people who kept Medi-Cal while asset limits were suspended may now be receiving notices reducing or ending their coverage. If you got one of these and believe the county miscounted your assets, that is a strong reason to request a hearing.

The 10-Day Advance Notice Rule

When the county plans to reduce or end your benefits, it cannot make the change immediately. The Notice of Action for any adverse action must be mailed at least 10 calendar days before the first of the month in which the change takes effect.¹ That 10-day window is your response period.

Look at the mailing date and the effective date. The gap between them is where your options live. If the county mailed the notice late or gave you fewer than 10 calendar days, the notice itself may be defective, which is an additional ground for a hearing.

If you ignore the notice, the action takes effect on the stated date. For an approval or a benefit increase that is fine. For a discontinuance or reduction, silence means acceptance: your benefits drop or end, and you lose the ability to hold your current coverage in place during an appeal. You still have 90 days from the notice date to request a hearing, but the further you get from the 10-day window, the harder retroactive restoration becomes.

Keeping Your Benefits During an Appeal

This is the most time-sensitive decision on the page. If you request your hearing before the effective date on the notice, your benefits continue at their current level while the appeal is pending.⁴ This continuation is called aid paid pending. Where the county was required to give 10-day advance notice, you must file by the effective date of the change. Where no 10-day notice was required, you have 10 days from the date of the notice itself.

Missing this window doesn’t kill your hearing — you still have the full 90 days. But your benefits drop or end while you wait for the decision, and for anyone in ongoing treatment that gap can be serious. If you’re considering a challenge, file first and refine the details later.

One caveat: if you receive aid paid pending and then lose the hearing, the county may seek repayment of benefits you received during the appeal. Weigh that risk, but for most people facing an incorrect discontinuance, maintaining coverage during the appeal is the right call.

How to Request a State Hearing

A state hearing is your formal right to challenge any county decision about your Medi-Cal eligibility, benefit level, or share of cost. An administrative law judge reviews the county’s decision independently, and the county has to prove it acted correctly. You do not need a lawyer, though having one helps.

The 90-Day Deadline

You have 90 days from the date on the Notice of Action to file your hearing request.⁵ The deadline is firm. Missing it means losing your hearing right unless you qualify for a good cause exception.

A different process applies if you’re in a Medi-Cal managed care plan and the plan itself denied a service or treatment. In that case, you generally must first file an appeal with the plan within 60 days of the plan’s notice, then request a state hearing if the internal appeal doesn’t resolve the issue.⁴

What to Include

You can use the hearing request section printed on the back of your notice, or write your request on any piece of paper. No special form is required. Include:

Your full name, mailing address, and phone number.
Your case number, printed on the front of the notice.
The county that took the action.
The program involved (Medi-Cal).
Why you disagree, stated specifically. If the county says your income is too high, state what your actual income is. If it miscalculated your share of cost, give the correct figure.
Any language or interpreter needs, including dialect.
Whether you want aid paid pending — this is what keeps your benefits at the current level while you appeal.

If someone else will handle the case for you, include their name, address, and phone number. You can authorize any individual or organization as your representative using the Appointment of Authorized Representative form (MC 382), available from your county office.⁶ The authorization can be limited to specific tasks or cover your full case.

Where to Send It

The California Department of Social Services accepts hearing requests four ways:⁷

Online through the Appeals Case Management System (ACMS) on the CDSS website.
By phone at (800) 743-8525.
By fax at (833) 281-0905.⁸
By mail to California Department of Social Services, State Hearings Division, P.O. Box 944243, Mail Station 9-17-442, Sacramento, CA 94244-2430.

You can also submit the request directly to your county welfare department at the address printed on the notice. Whichever route you use, keep a copy. CDSS will send confirmation and, later, a notice with the hearing date, time, and location.

If you face a medical emergency and cannot wait for the standard schedule, you can request an expedited hearing by calling the State Hearings Division at (800) 743-8525. Expedited hearings are only available by phone.⁷

Preparing for the Hearing

Once your hearing is scheduled, the county must prepare a written position statement explaining why it made the decision. It must make this statement available to you at the county office no later than two working days before the hearing.⁹ If the county fails to provide it on time, or changes it after giving it to you, you can request a postponement.

Read the position statement closely. It tells you exactly what evidence the county is relying on, which shows you where to focus your own preparation. Gather documents that directly contradict the county’s position: recent pay stubs for an income dispute, bank statements for an assets dispute, proof of address for a residency issue. Organize the paperwork so you can find things quickly.

The hearing itself is less formal than a courtroom. An administrative law judge conducts it, and you can appear in person or by phone. You explain your side, present documents, and respond to the county’s position. The judge issues a written decision, typically within 90 days of your original hearing request.

Resolving the Dispute Without a Hearing

Many disputes are settled before anyone appears before a judge. You can contact the county welfare department to discuss the issue informally at any time after you receive the notice.⁴ Sometimes the county recognizes an error once you show your documentation and corrects the action without a hearing.

If you’ve already filed and then reach an agreement with the county, you can formally withdraw your request using the CDSS withdrawal form (DPA 315). A standard withdrawal ends your hearing rights on that issue. A conditional withdrawal is often the smarter move: it gives the county 30 days to issue a corrected determination, and if you’re not satisfied with the result, you can file a new hearing request within 90 days of the county’s revised notice.¹⁰ A conditional withdrawal requires both your signature and a county representative’s signature.

Aid paid pending stops the moment you withdraw. If you’re receiving continued benefits during the appeal, don’t withdraw until the county has actually corrected your case in its system, not just promised to.

If You Missed the 90-Day Deadline

You can still request a hearing after 90 days by showing good cause for the delay. Good cause means a serious reason beyond your control, and the state weighs how long you waited, how quickly you acted once the obstacle cleared, and whether the delay harmed the county’s ability to respond. The absolute outer limit is 180 days from the date the county took the action. No hearing requests are granted after that, regardless of the reason.⁵

Not understanding the notice does not, by itself, count as good cause. California requires notices to be sent in the beneficiary’s primary language, and the state treats a language-compliant notice as sufficient even if the recipient didn’t fully grasp it. If you need help understanding your notice, reach out to a legal aid organization before the deadline runs.

Free Help With Your Notice or Hearing

You don’t have to handle this alone. The Health Consumer Alliance is a statewide partnership that provides free assistance to Californians with health coverage problems, including help reading a Notice of Action, preparing for hearings, and negotiating with counties. You can reach the Alliance by phone or in person through local legal aid offices across the state.¹¹ DHCS also maintains a directory of legal services organizations by county that assist Medi-Cal enrollees.¹²

If your income is low enough to qualify for Medi-Cal, you likely qualify for free legal representation through one of these offices. Legal aid attorneys handle Medi-Cal hearings routinely and know the common county errors and how to challenge them. Even a single phone consultation before your hearing can change the outcome.

1
Legal Information Institute. California Code of Regulations 22 CCR 50179 – Notice of Action – Medi-Cal-Only Determinations or Redeterminations
2
California Department of Health Care Services. Medi-Cal Notice of Action (NOA) – Frequently Asked Questions
3
California Department of Health Care Services. Asset Limits FAQs
4
Department of Health Care Services. Medi-Cal Fair Hearing
5
California Department of Social Services. General Information Regarding a State Hearing
6
Department of Health Care Services (DHCS). Appointment of Authorized Representative (MC 382)
7
California Department of Social Services. Hearing Requests
8
California Department of Social Services. State Hearings
9
California Department of Social Services. Division 22 State Hearing and Request for Review
10
California Department of Social Services. Withdrawal/Conditional Withdrawals Of Request For Hearing (DPA 315)
11
the Health Consumer Alliance. Health Consumer Alliance
12
California Department of Health Care Services. Legal Services Office for Assistance for Medi-Cal Managed Care