Insurance Affordability Programs Eligibility Appeals Hearing Results

The Department of Health Care Services (DHCS) assigns responsibility for conducting fair hearing requests (appeals) to the California Department of Social Services (CDSS). CDSS receives appeal requests, conducts hearings through their statewide network of administrative law judges, and renders decisions.

CDSS provides these services to DHCS through a contract called an interagency agreement. In addition to the interagency agreement, the Delegation Order gives an Administrative Law Judge the authority to review and adopt decisions for hearings. Hearing requests (appeals) may be filed for cases involving mixed determinations, such as when household members applied for and/or had eligibility determinations made for the two programs (i.e., parents were eligible for Covered California and the child(ren) were eligible for Medi-Cal).