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Medi-Cal Fair Hearing

If you have applied for, have received, or are currently receiving benefits/services from Medi-Cal AND you have a complaint about how your benefits/services are/were handled, or your services have been denied or modified, you may:

 
You must file your request within 90 days of receiving the Notice of Action (NOA). You may be able to file after 90 days if you have a good reason, like illness or a disability. Your benefits will continue pending review (Aid Paid Pending) if the hearing is filed within 10 days of receiving the NOA. This process allows you to continue receiving services while the case is being reviewed.

Your Hearing Rights

Requesting a state hearing:
You may complete the "Request for State Hearing" on the back of the NOA. Please provide all requested information such as your full name, address, telephone number, the name of the county that took the action against you, the aid program(s) involved, and a detailed reason why you want a hearing. If you have trouble understanding English, be sure to tell us your language (and dialect) so we can arrange for you to have language assistance at the hearing. If you have chosen an authorized representative, be sure to tell us his/her name and address. Please try to write as neatly as possible. If you wish, you may attach a letter to explain why you believe the county action is not correct. It is always a good idea to keep a copy of your hearing request. For more information, please visit the page on Your Hearing Rights.
 
Then you may submit your request one of these ways:
  1. To the county welfare department at the address shown on the Notice of Action.
  2. To the California Department of Social Services
    State Hearings Division
    P.O. Box 944243, Mail Station 9-17-37
    Sacramento, California 94244-2430.
  3. To the State Hearings Division at fax number 916-651-5210 or 916-651-2789.
  4. To the California Department of Social Services at the online hearing request page.
OR

 

You can make a toll-free call to request a State Hearing. Please notedue to a high volume of calls, phone lines are very busy. 

California Department of Social Services
Public Inquiry and Response
Phone 1-800-952-5253 (Voice)
1-800-952-8349 (TDD)
NOTE: The State Hearings Division cannot accept requests for a State Hearing via e-mail.

For additional information, visit the State Hearings Requests with the Department of Social Services.

Accessing Your Personal Health Information

You have the right to inspect, review, and receive a copy of your personal health information (PHI). You must be the individual, or the parent, guardian, or personal representative of the individual for whom you seek documentation. To request copies of your PHI documents, please use the links below to download the request form.
  • Special Process for Requests for Information Related to temporary medical exemption (MER) from managed care enrollment
 
The Medi-Cal Program provides medical services to qualified beneficiaries in California through managed care health plans that contract with the Department Health Care Services (DHCS) or individual providers on a fee-for-service (FFS) basis. With a few exceptions, Medi-Cal beneficiaries are required to enroll in a managed care plan for their health care services. Beneficiaries that have pre-existing complex medical conditions and are currently undergoing an active course of medical treatment from a FFS provider can request a temporary medical exemption (MER) from managed care enrollment by submitting HCO Form 7101. DHCS reviews all documentation submitted with a MER and approves or denies all MERs, in accordance with Title 22, California Code of Regulations, Section 53887.
 
Beneficiaries have the right to examine all documents DHCS considers to determine whether a MER should be granted or denied. Beneficiaries can contact DHCS to request their documentation or ask questions about their MER or the MER process. To request documents related to a medical exemption request, please visit the Medical Exemption Request Documentation page.

Filing a discrimination complaint

If you think discrimination has affected your benefits or services, you may file a discrimination complaint with the DHCS Office of Civil Rights below:
Office of Civil Rights
Department of Health Care Services
P. O. Box 997413, MS 0009
Sacramento, CA 95899-7413
Phone: 916-440-7370
Email: CivilRights@dhcs.ca.gov
You may use the ADA Title VI Discrimination Complaint form to submit your complaint to DHCS Office of Civil Rights. The form also contains additional information about your rights. A complaint should be filed as soon as possible or within 180 days of the last act of discrimination. If your complaint involves matters that occurred longer ago than this and you are requesting a waiver of the time limit, you will be asked to show good cause why you did not file your complaint within the 180-day period.
 
You may also submit a discrimination complaint to United States Department of Health and Human Services, Office of Civil Rights. Additional information on filing discrimination complaints is available on the Non-Discrimination Policy and Language Access webpage.
 

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Last modified on: 7/20/2017 8:22 AM