A Medi-Cal Notice of Action is the written letter your county welfare department sends whenever it approves, denies, changes, or ends your Medi-Cal coverage. It tells you what the county is doing, why, and when the change takes effect, and it explains how to challenge the decision through a State Fair Hearing. If you disagree, you generally have 90 days from the mailing date to request that hearing, and if you act quickly enough you can keep your current benefits running the entire time your appeal is pending.
What the Notice Is Telling You
Every Notice of Action follows the same structure, and each part matters if you’re thinking about an appeal.
The action section states exactly what is happening: approval, denial, termination, a Share of Cost change, or a move between Medi-Cal programs. The reason section explains why, and it should cite specific rules from the California Manual of Policies and Procedures or the Welfare and Institutions Code rather than vague language about “eligibility.” The effective date is when the change actually hits your coverage, and nearly every deadline that follows runs from that date or the mailing date, so write both down. Finally, the back of the notice carries your hearing rights, usually with a tear-off form and instructions for filing by phone, fax, mail, or online.1Legal Information Institute. California Code of Regulations 22 CCR 50179 – Notice of Action – Medi-Cal-Only Determinations or Redeterminations
Read the reason section against your actual situation. If the county cites an income change but your income hasn’t moved, or says you failed to return a renewal form you actually submitted, that mismatch is often the strongest argument on appeal. You also have the right to see your entire case file, including every document the county plans to rely on, before the hearing takes place.2Medicaid.gov. Medicaid Fair Hearings: A Partner Resource
Deadlines to Act
Two sets of deadlines run at the same time: the county’s deadline to notify you, and your deadline to respond.
When the action reduces or ends your benefits, the county must mail the notice at least 10 calendar days before the effective date. That’s called “timely notice,” and it exists so you have time to appeal and keep your benefits going.3Department of Health Care Services. All County Welfare Directors Letter 15-27 – County Requirements for Issuing Appropriate Notices of Action A shorter form called “adequate notice” applies in limited situations, such as when you voluntarily ask to end coverage or when a confirmed data match triggers an automatic adjustment, but even adequate notice must reach you no later than the effective date. If you received the notice after the change already took effect and you didn’t ask for the change, the county likely violated the timely notice rule, which itself is an argument for restoring benefits.
On your side, you have 90 days from the mailing date to request a State Fair Hearing for most decisions. There is a longer window for notices tied to annual redetermination, including coverage terminations, reductions from full-scope to restricted Medi-Cal, and Share of Cost increases: California has temporarily extended that deadline to 120 days from the mailing date. The extension took effect April 1, 2023, and remains in place until further notice.4California Department of Social Services. Hearing Requests
If the notice came from a Medi-Cal managed care health plan rather than the county, the process adds a step. You generally have to file an internal appeal with the plan first, within 60 days of the notice. If the plan denies the appeal or doesn’t respond within 30 days, you then have 120 days from the plan’s decision to request a State Fair Hearing.4California Department of Social Services. Hearing Requests
Keeping Your Coverage While You Appeal
Filing a hearing request can keep your current Medi-Cal benefits running throughout the appeal. The protection is called “aid paid pending,” and the timing of your request controls whether you get it.
If the county gave you timely notice, you must request the hearing before the effective date of the action to keep benefits going automatically.5Department of Health Care Services. Medi-Cal Fair Hearing If the county acted without proper advance notice, federal rules let you get benefits reinstated by requesting a hearing within 10 days of receiving the notice. Receipt is presumed five days after the date printed on the notice unless you can show it arrived later.6GovInfo. 42 CFR 431.230 – Maintaining Services
People often worry about owing money if they keep benefits and then lose the appeal. In California, you will not be billed for services you received while the appeal was pending, even if the final decision goes against you.7Department of Health Care Services. Your Rights Under Medi-Cal Federal law allows states to recover those costs, but California has chosen not to. There is no financial downside to filing early, so if you’re within the window, request the hearing immediately, before you’ve finished pulling together your evidence.
How to File the Hearing Request
You can request a State Fair Hearing through the California Department of Social Services in any of four ways.8Justia. California Welfare and Institutions Code 10950-10967 – Hearings
- Online, at cdss.ca.gov/hearing-requests.
- By phone, at the State Hearings Division: (800) 743-8525 or (855) 795-0634.9California Department of Social Services. State Hearings
- By fax, to (833) 281-0905.
- By mail, using the form on the back of your notice sent to the address printed on it.
Whichever method you choose, keep proof you filed, whether a confirmation page, a fax log, or a certified mail receipt.
If You’ve Already Missed the Deadline
Filing late doesn’t automatically end your right to a hearing, but you’ll need to show “good cause” for the delay. Federal regulations recognize several qualifying circumstances:10eCFR. 42 CFR 478.22 – Good Cause for Late Filing
- Serious illness or hospitalization that prevented you from filing in person, by phone, or in writing.
- A death or serious illness in your immediate family.
- Records destroyed by fire, flood, or similar event.
- Misleading or incorrect information from the county about the deadline or how to file.
- A diligent but unsuccessful effort to obtain information you needed within the filing period.
- Filing in good faith with the wrong government agency before the deadline expired.
The standard is flexible. Any unusual or unavoidable circumstance that kept you from knowing you needed to file, or from filing on time, can qualify. File the request anyway and include a written explanation of what happened.
Getting Help and Language Assistance
You don’t have to go through this alone. Federal regulations guarantee your right to appoint an authorized representative — a family member, friend, social worker, or attorney — to act for you throughout the process.11eCFR. 42 CFR 435.923 – Authorized Representatives Your representative can file the hearing request, receive copies of all notices, review your case file, and speak for you at the hearing. The designation must be in writing and signed, though the county must accept electronic and faxed signatures. A power of attorney or court-ordered guardianship counts as a valid written designation on its own. The authorization lasts until you revoke it or your representative steps down.
Legal aid organizations across California offer free representation to Medi-Cal beneficiaries in fair hearings. If you can’t afford a private attorney, contact your county’s legal aid office or the Health Consumer Alliance, which runs a statewide helpline for health coverage disputes.
If English isn’t your primary language, interpretation and translation are free. Under Section 1557 of the Affordable Care Act, every county Medi-Cal office must provide qualified interpreters for phone calls and in-person contact, and must offer translated written materials for critical documents like the Notice of Action.12U.S. Department of Health and Human Services. Dear Colleague Letter: Section 1557 of the Affordable Care Act and Language Access The notice itself should carry short “taglines” in at least the top 15 non-English languages spoken in California, telling you free services are available.13Health Resources and Services Administration. Notices of Nondiscrimination and Taglines The county cannot require you to bring your own interpreter or use a family member, including a child, to translate during hearings or conversations about your case. If your notice arrived only in English and you need it translated to understand it, call the county office listed on the notice and ask for a translated copy.
Preparing for the Hearing
Hearings are less formal than courtroom proceedings. There’s no jury, and strict rules of evidence don’t apply, but preparation still drives outcomes. An administrative law judge decides the case on the evidence in front of them, so showing up organized matters.
Start by requesting your complete case file from the county. You have the right to examine every document the county plans to use, and the county must give you a reasonable chance to review it before the hearing.2Medicaid.gov. Medicaid Fair Hearings: A Partner Resource You can also ask for the county’s “position statement,” which spells out the county’s legal argument in more detail than the notice does.
Build your case around the reason section of the notice. If the county says your income exceeds the limit, bring pay stubs, tax returns, or an employer letter showing your actual earnings. If the notice cites a failure to respond to a renewal, bring a copy of what you submitted along with a delivery confirmation, screenshot, or fax log. The strongest appeals pair documentary evidence with a short, clear explanation of why the county’s stated reason doesn’t match reality.
You can appear in person, by phone, or through your authorized representative, and you can bring witnesses. Testimony is given under oath, but the judge will walk you through the process informally.8Justia. California Welfare and Institutions Code 10950-10967 – Hearings
If your health situation is urgent, ask for an expedited hearing. You’ll need to explain, or have your doctor document, how waiting the standard timeframe could seriously harm your health or ability to function. If the State Hearings Division grants expedited status, a decision can come within three days of its receiving your case file. For standard hearings, the state generally has 90 days from the date you filed your request to issue a final decision. If the decision goes your way, the county must restore your benefits retroactively and correct your records. If it goes against you and you had aid paid pending, your coverage ends as of the decision date, with no bill for what you used during the appeal. Further options exist beyond that point, including a rehearing from the CDSS director or a filing in superior court, but those paths are more complex and typically call for legal representation.