A State Hearing is a meeting with people from the California Department of Social Services (DSS). A judge will help to resolve your problem. You can ask for a State Hearing only if you have already filed an appeal with PHC California and you are still not happy with the decision, or if you have not received a decision on your appeal after 30 days, and you have not requested an independent medical review (IMR).
You must ask for a State Hearing within 120 days from the date on the notice telling you of the appeal decision. Your PCP can ask for a State Hearing for you with your written permission and if he or she gets approval from DSS. You can also call DSS to ask the State to approve your PCP’s request for a State Hearing.
To request a State Hearing, contact:
California Department of Social Services
State Hearings Division
P.O. Box 944243, MS 9-17-37
Sacramento, CA 94244-2430
Tel (800) 952-5253;
TTY users call (800) 952-8349
Fax (916) 309-3487
You or someone you appoint to represent you may request a State Hearing. A provider (with your written consent) may also request a State Hearing on your behalf. The parties to a State Hearing include you, your representative or a representative of a deceased member and representatives from PHC California.
The State must reach a decision to a State Hearing within 90 calendar days from the date of the hearing request. In the case of expedited hearings, the State must reach its decision within three (3) working dates from the date of the request.
If the final resolution of the State Hearing is in your favor, PHC California will authorize or provide the disputed services as required with 72 hours from the date we receive notice from the State reversing our determination.
If the final resolution of the State Hearing is not in your favor, you may be liable for all costs accrued while the State Hearing was pending. PHC California may recover the cost of the disputed services furnished while the State Hearing was pending.
For more information about the appeals process, see Section 5, Reporting and Resolving Problems, in the Member Handbook (Combined Evidence of Coverage (EOC) and Disclosure Form) (effective 2022).
DHCS 030716 PHC FR Form 1.0