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Your Hearing Rights

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You have the right to ask for a hearing if you disagree with any county action. You can ask for a hearing even if you do not get a written notice from the county. You have only 90 days to ask for a hearing. The 90 days started the day after the county gave or mailed you this notice. If you have a good reason why you were not able to file for a hearing within the 90 days, you may still ask for a hearing.

If you ask for a hearing before an action on Cash Aid, Medi- Cal, CalFresh (Food Stamps), In Home Supportive Services, foster care, or Child Care takes place:

While You Wait for a Hearing Decision for Welfare-to-Work:

Cal-Learn:

OTHER INFORMATION

Medi-Cal Managed Care Plan Members: If you receive your Medi-Cal benefits through a health plan (for example: Anthem Blue Cross, Partnership HealthPlan of California, Gold Coast Health Plan), the action on the Notice of Action may stop you from receiving benefits from your plan. You may wish to contact your plan's membership services if you have questions. You can find their contact information on your health plan card or by contacting the County.

Child and/or Medical Support: the local child support agency will help collect support at no cost even if you are not on cash aid. If they now collect support for you, they will keep doing so unless you tell them in writing to stop. They will send you support money collected until all support you are owed is paid or you go back on aid.

Family Planning: Your welfare office will give you information when you ask for it.

Hearing File: If you ask for a hearing, the State Hearing Division will set up a file. You have the right to see this file before your hearing and to get a copy of the county's written position on your case at least two days before the hearing. The state may give your hearing file to the Welfare Department and the U.S. Departments of Health and Human Services and Agriculture. (W&I Code Sections 10850 and 10950.)

TO REQUEST A HEARING

To Get Help: You can ask about your hearing rights or for a legal aid referral at the toll-free state phone numbers listed above. You may get free legal help at your local legal aid or welfare rights office.

If you do not want to go to the hearing alone, you can bring a friend or someone with you.

 

  • Personal Information

    Required Indicates required field

    Provide the information for the person whose:

    • benefits/services were denied, changed, or stopped
    • home approval was denied or discontinued

    Are you completing this form for someone else?

    Language Information

    Interpreter Needed?

    Sign Language Interpreter Needed?

    Claimant Contact Information

    Special Accommodations

  • Appeal Information

    Authorized Representative Information

    An Authorized Representative is any person you want to help with your appeal. They do not need to be an attorney or professional advocate.

    Be sure to come to an agreement with an attorney or professional advocate before including their information here.

    Would you like someone to be your Authorized Representative?

    Aid Paid Pending

    If you ask for a hearing before an action on Cash Aid, Medi-Cal, CalFresh, or Child Care takes place:

    • Your Cash Aid or Medi-Cal will stay the same while you wait for a hearing.
    • Your Child Care Services will stay the same while you wait for a hearing.
    • Your CalFresh benefits will stay the same until the hearing or the end of your certification period, whichever is earlier.

    If the hearing decision says the County was right, you will need to repay any extra Cash Aid, CalFresh or Child Care Services you got. To ask that the County lower or stop your benefits before the hearing, choose "Yes" below

    Do you want the county to lower or stop your benefits as they proposed before the hearing?

    Lower or stop APP for: (select all that apply)


    Have you been disenrolled and would like to keep your Covered California coverage?

    Coverage Options

    Expedite Hearing Request

    Expedited hearings are processed and scheduled faster than a normal fair hearing. However, expedited hearings are only for urgent issues and all expedited hearing requests are reviewed by the State. You will get a separate letter stating whether an expedited hearing request was granted or denied.

    Do you want an expedited hearing?

    Add Documents

    Please attach any documents that support your hearing request. If you do not have digital copies of your documents, you can contact the State Hearings Division at 1-800-743-8525 and a Customer Service representative will provide you with other ways to submit your documents.

    Allowed file type include: DOCX, PDF, JPG, PNG. If the file you want to upload is not being accepted, contact 1-800-743-8525.

    Would you like to attach any documents related to your appeal?

Text was not properly entered.

Please enter the letters below to complete your hearing request:

Appeal has been submitted.