If the county or the California Department of Health Care Services denied, reduced or stopped Medi-Cal, a state hearing can be requested. The California Department of Social Services (CDSS) says a person has 90 days to request one and, after 90 days, must prove a good reason for asking late. For Medi-Cal renewal decisions, CDSS states a temporary 120-day window that does not apply to new applications. If a Medi-Cal managed care plan made the decision, the person generally must first appeal to the plan, within 60 calendar days of the date of its notice of action.
A denial letter often arrives at a hard moment: a parent has just moved into a nursing home, a spouse at home is trying to work out what the couple can keep, and the monthly bill is already running. The notice is written in agency language, it carries a deadline, and it may be the first time anyone in the family has dealt with a government appeal. This guide walks through the California Medi-Cal appeal in order: what to have in hand, how the hearing request works, how families prepare, what the hearing and decision stage involve, and where long-term-care cases tend to get harder.
Before Starting: What to Have in Hand
The starting point is the Notice of Action, the written letter from the county or the plan that announces the decision. It is the document that opens the right to appeal. The back of a county Notice of Action carries a "Request for State Hearing" form, according to the CDSS Hearing Requests page. The notice explains which decision was made. Its date matters: CDSS counts the plan appeal's 60 calendar days from the date of the notice of action, and the temporary 120-day renewal window from the date the notice of action is mailed.
There are two separate tracks, and the notice shows which one applies:
- A state hearing. This is the formal appeal run by the California Department of Social Services (CDSS) State Hearings Division. It covers actions taken by a county or by the Department of Health Care Services (DHCS).
- A managed care plan appeal. A Medi-Cal managed care plan is a health plan that arranges a member's Medi-Cal care. When the plan itself takes an action, the plan's internal appeal generally comes first.
Families commonly gather these papers before filing:
- the Notice of Action and its envelope
- earlier letters from the county or plan
- medical records or doctor's letters, if a service was denied
- bank statements, income records and property records, if eligibility was denied
Whether Medi-Cal keeps paying while an appeal is pending depends on California's current rules and on the kind of action. A termination or reduction is treated differently from a first-time denial, and the notice and the county set out what applies.
Step 1: Request a State Fair Hearing
A state hearing (often called a fair hearing) is an independent review of the county's or DHCS's decision. Under the CDSS Hearing Requests page, a person who disagrees with an action taken by the county or DHCS has 90 days to request one. After 90 days, the person must prove they had a good reason for asking late. CDSS also states that, effective April 1, 2023 and until further notice, a person has 120 days from the date the notice of action is mailed to request a hearing about a Medi-Cal renewal (redetermination) decision, including terminations of eligibility, reductions from full to limited benefits, and increases in beneficiary liability or share-of-cost. That extended time frame does not apply to new Medi-Cal applications, medical exemption requests or hearing requests about a particular treatment or service.
A hearing can also be requested when someone turned in an application or other information and the county did not act on it. Federal guidance on the Medicaid.gov Eligibility Policy page says every state must offer a fair hearing for a denial, for an action the person believes was wrong, or when the state has not acted with reasonable promptness.
CDSS accepts requests three ways:
- Online, through the State Hearings Division's online request.
- By phone, toll free at (800) 743-8525. An expedited hearing is also requested this way.
- In writing, on the back of the Notice of Action or on a separate sheet.
CDSS asks for the person's full name, address and telephone number, the county that took the action, the aid program involved, and a detailed reason for wanting a hearing. A request also names any authorized representative, meaning the person chosen to act for the applicant, with that person's address. It can note the language and dialect, so that CDSS can arrange language assistance at the hearing. A letter explaining why the county is wrong can be attached, and CDSS suggests keeping a copy.
Managed care plan decisions follow a different path. Under the same CDSS page, a member generally must first appeal to the plan within 60 calendar days of the plan's notice. If the plan's appeal does not resolve the issue, the member has 120 calendar days from the plan's Notice of Appeal Resolution to request a state hearing. If no Notice of Appeal Resolution arrives within 30 days of filing the plan appeal, a state hearing can be requested then. In practice, this means a state hearing on a plan decision generally waits until one of those two points is reached.
Step 2: Prepare the Case
This stage is where the family lines up the denial reason against the records. The Notice of Action gives the reason for the decision, and preparation usually centers on that reason.
For long-term-care eligibility denials, the issue is often assets. A countable asset is property Medi-Cal counts toward its limit. According to the DHCS Asset Limit Frequently Asked Questions, California began counting assets again on January 1, 2026. Through June 30, 2027, that page sets the limit at $130,000 for one person, plus $65,000 for every extra person in the house, up to 10 people. Starting July 1, 2027, it sets the limit at $21,000 for one person and $31,000 for two people, plus $1,550 for every extra person, up to 10 people. The page says the main home and main vehicle are not counted, but second homes and second vehicles are. More detail is in this site's guide to California Medi-Cal asset limits.
Transfers are another common reason for denial. DHCS states that for a person who moves into a nursing home, Medi-Cal looks at assets given away in the 30 months before entering the facility. This is the look-back period. Transfers made before January 1, 2026 are not counted. Transfers made on or after that date may cause a penalty that delays coverage.
Records that bear on these questions include:
- statements showing the balances on the dates that matter
- receipts showing assets were spent on things like medical bills or debts
- deeds
- any trust documents
On trusts, CMS notes that a trust funded with the applicant's own money can be treated as available for eligibility, so trust paperwork is often part of the file. How spending down to the limit works is covered in this site's page on the Medicaid spend-down attorney role.
A written statement explaining the family's position can be sent with the request, and an authorized representative can be named.
Step 3: Attend the Fair Hearing
Sitting across from a county representative can feel intimidating for a spouse or adult child who has never been in an administrative hearing. Knowing what to bring can make that easier.
What families commonly bring:
- organized copies of everything already sent
- the Notice of Action
- the written statement prepared in Step 2
How the hearing is held, who attends and how evidence is presented all follow the State Hearings Division's current procedures. Those details are given in the hearing notices CDSS sends, so those notices are worth reading closely when they arrive.
CDSS asks that a request name any language assistance needed and the name and address of any authorized representative. CDSS lists a phone call to the State Hearings Division as the way to request an expedited hearing.