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Covered CA Eligiblity Appeals starting on Page 280
Covered CA Eligiblity Appeals starting on Page 280

2. Covered California Eligibility Appeals

a. Notice: Content and Time Requirements

b. Request for Hearing c. Expedited Appeals

d. Eligibility Pending Appeal – Continuing Enrollment

e. Informal Resolution

f. Notification of Hearing and Position Statement

g. The Fair Hearing

h. Hearing Decision and Other Post-Hearing Processes

3. Dual Agency Appeals

a. Shared Appeals Entity

b. Informal Resolution Process

c. The Fair Hearing

4. Medi-Cal Access Program (MCAP) Eligibility Appeals

C. Moving Between Programs

1. Covered California to Medi-Cal

2. Medi-Cal to Covered California


What if Covered CA says they can’t write you because they say Medi-Cal is covering you, but Medi-Cal lapsed your coverage over a year ago?

If the county determines that a beneficiary is no longer eligible for Medi-Cal, the county must issue a Notice of Action to the beneficiary ten days prior to the date of termination.391

391. 42 C.F.R. § 431.213; 22 CCR §§ 50179(d). The requirements for termination notices are discussed in detail at Section B.1.a of this Chapter

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