How do I appeal a Medi-Cal decision?

There are multiple ways to dispute a Medi-Cal decision depending on the type of conflict you are experiencing. Your first steps depend on what type of dispute you have.

Here are some examples of types of disputes and how to initiate the appeal process:

• Initial determination of Medi-Cal ineligibility → File a state hearing request.

• Termination of existing Medi-Cal coverage → File a state hearing request (in writing, within ten days, for aid paid pending appeal).

• Plan enrollment issues → Contact the plan or Health Care Options and/or the Ombudsman’s office, then file a state hearing request if they cannot resolve the issue or point you in the right direction.

• Disputes over medical necessity, coverage, providers, access to care, etc. with a managed care plan → File a grievance with managed care plan.

• Disputes over medical necessity, coverage, providers, access to care, etc. with fee for service Medi-Cal → File a state hearing request.

• IHSS disputes → File a state hearing request.

For more information on each of these, see our full article Medi-Cal Appeals.