What Is A State Fair Hearing?
A State Fair Hearing is an independent review conducted by the California Department of Social Services to ensure you receive the specialty mental health services to which you are entitled under the Medi-Cal program.
What Are My State Fair Hearing Rights?
You have the right to:
· Have a hearing before the California Department of Social Services (also called a State Fair Hearing)
· Be told about how to ask for a State Fair Hearing
· Be told about the rules that govern representation at the State Fair Hearing
· Have your benefits continued upon your request during the State Fair Hearing process if you ask for a State Fair Hearing within the required timeframes.
When Can I File For A State Fair Hearing?
You can file for a State Fair Hearing:
· If you have competed the MHP’s Grievance and/or Appeals process.
· If your MHP or one of the MHP’s providers decides that you do not qualify to receive any Medi-Cal specialty mental health services because you do not meet the medical necessity criteria. (See page 17 for information about medical necessity.)
· If your provider thinks you need a specialty mental health service and asks the MHP for approval, but the MHP does not agree and says “no” to your provider’s request, or changes the type or frequency of service.
· If your provider has asked the MHP for approval, but the MHP needs more information to make a decision and doesn’t complete the approval process on time.
· If your MHP doesn’t provide services to you based on the timelines the MHP has set up.
· If you don’t think the MHP is providing services soon enough to meet your needs.
· If your grievance, appeal or expedited appeal wasn’t resolved in time.
· If you and your provider do not agree on the services you need.
How Do I Request A State Fair Hearing?
You can request a State Fair Hearing directly from the California Department of Social Services. You can ask for a State Fair Hearing by writing to:
State Hearing Division
California Department of Social Services
P.O. Box 9424443, Mail Station 19-37
Sacramento, CA 94244-2430
To request a State Fair Hearing, you may also call (800) 952-5253, send a fax to (916) 229-4110, or write to the Department of Social Services/State Hearings Division, P.O. Box 944243, Mail Station 19-37, Sacramento, CA 94244-2430.
Is There a Deadline for Filing For A State Fair Hearing?
If you didn’t receive a notice of action, you may file for a State Fair Hearing at any time.
Can I Continue Services While I’m Waiting For A State Fair Hearing Decision?
You can continue services while you’re waiting for a State Fair Hearing decision if your provider thinks specialty mental health service you are already receiving needs to continue and asks the MHP for approval to continue, but the MHP does not agree and says “no” to your provider’s request, or changes the type or frequency of service the provider requested. You will always receive a Notice of Action from the MHP when this happens. Additionally, you will not have to pay for services given while the State Fair Hearing is pending.
What Do I Need To Do if I Want to Continue Services While I’m Waiting For A State Fair Hearing Decision?
If you want services to continue during the State Fair Hearing process, you must request a State Fair Hearing within 10 days from the date your notice of action was mailed or personally given to you.
What If I Can’t Wait 90 Days For My State Fair Hearing Decision?
You may ask for an expedited (quicker) State Fair Hearing if you think the normal 90-day time frame will cause serious problems with your mental health, including problems with your ability to gain, maintain, or regain important life functions. The Department of Social Services, State Hearings Division, will review your request for an expedited State Fair Hearing and decide if it qualifies. If your expedited hearing request is approved, a hearing will be held and a hearing decision will be issued within 3 working days of the date your request is received by the State Hearings Division.