What is a Medi-Cal fair hearing?

A Medi-Cal state hearing (also sometimes called a fair hearing), is an administrative proceeding where you and the state, county, or managed care plan have a chance to present the issue in dispute, submit evidence in support of your position, and receive a decision from an impartial hearing officer known as an Administrative Law Judge (ALJ). A state hearing is a legal proceeding, but the rules are not quite as stringent as they are in a civil or criminal court. While many families choose to hire an attorney or advocate, the process is designed for individuals and families to be able to self-advocate.

Before you file for a hearing, you have to file a grievance first. If the grievance doesn’t pan out, you have the option is to request a state hearing. The question is always about medical necessity and whether your health plan is obligated to provide coverage.

You can learn more in our article about Medi-Cal appeals.