Common Questions

If you have a question not listed below, please call the Telephone Service Center Phone Line at 1‑800‑322‑6384. The call is free, and Medi‑Cal Dental representatives are available to assist you Monday through Friday, between 8 a.m. – 5 p.m. PT.
Common Questions

What is a State Hearing?

State Hearing Process

If treatment your dental provider requested has been denied or changed, if you are not happy with the outcome of your complaint, or your Conlan refund request was denied (see Cost of Dental Services section in the Member Handbook), you may request a State Hearing through the California Department of Social Services (CDSS). Your local County Social Services office can assist you with this request. You can find a complete list of county offices on the Department of Health Care Services website here.

You can represent yourself at the State Hearing. A friend, lawyer, or any other person can also represent you. You are responsible for making the arrangements if you want someone else to represent you. To get free legal help, call the Public Inquiry and Response Unit of CDSS at 1-800-952-5253. This unit can also help with general information about the State Hearing process.

Requesting a State Hearing will not affect your eligibility for dental services. You will not be penalized for asking for a hearing. We will maintain confidentiality during the entire complaint process.

Legal Help

You may be able to get free legal help. Call the California Department of Consumer Affairs at 1-800-952-5210, or TTY 1-800-326-2297. You may also call the local Legal Aid Society in your county at 1-888-804-3536.

When do I ask for a State Hearing?

If you disagree with the Notice of Medi-Cal Dental Action you received, you should first discuss different treatment plans with your dental provider to get the best care that is covered by the Medi-Cal Dental Program. If you and your dental provider agree that a different treatment plan is not an option, you have 90 days after the date on that notice to request a State Hearing.

How do I start the process?

You can start the process by calling toll-free 1-800-952-5253 or by creating an account.

You may send a copy of the entire Notice of Medi-Cal Dental Action or write to:

California Department of Social Services State Hearings Division
P.O. Box 944243 MS 9-17-37
Sacramento, CA 94244-2430

If you are calling or writing to request a State Hearing, be sure to include the Document Control Number (DCN) located on your Notice of Medi-Cal Dental Action. The DCN identifies the Treatment Authorization Request that the services were denied on. Including the DCN helps speed up processing your request. If you are calling or writing to request a State Hearing because you are dissatisfied with the result of your complaint case, be sure to include the Service Form identification included on your denial letter.

Accessing Your Personal Health Information

You have the right to review and get a copy of your personal health information (PHI). You must be the individual, or the parent, guardian, or personal representative of the individual for whom you seek documentation. To request copies of your PHI documents, please see the Privacy Forms page or use the link below to download the request form.

The Medi-Cal Program provides medical services to qualified members in California through managed care health plans that contract with the Department Health Care Services (DHCS) or individual providers on a fee-for-service (FFS) basis. With a few exceptions, Medi-Cal members are required to enroll in a managed care plan for their health care services. Members that have pre-existing complex medical conditions and are currently undergoing an active course of medical treatment from a FFS provider can request a temporary medical exemption (MER) from managed care enrollment by submitting HCO Form 7101. DHCS reviews all documentation submitted with a MER and approves or denies all MERs, in accordance with state regulations.

Members have the right to examine all documents DHCS considers to determine whether a MER should be granted or denied. Members can contact DHCS to request their documentation or ask questions about their MER or the MER process. To request documents related to a medical exemption request, please visit the Medical Exemption Request Documentation page.

Filing a Discrimination Complaint

If you think discrimination has affected your benefits or services, you may file a discrimination complaint with the DHCS Office of Civil Rights below:

Office of Civil Rights
Department of Health Care Services
P. O. Box 997413, MS 0009
Sacramento, CA 95899-7413
Phone: (916) 440-7370
Email: CivilRights@dhcs.ca.gov

You may use the ADA Title VI Discrimination Complaint form to submit your complaint to DHCS Office of Civil Rights. The form also contains additional information about your rights. A complaint should be filed as soon as possible or within 180 days of the last act of discrimination. If your complaint involves matters that occurred longer ago than this and you are requesting a waiver of the time limit, you will be asked to show good cause why you did not file your complaint within the 180-day period.

You may also submit a discrimination complaint to United States Department of Health and Human Services, Office of Civil Rights. Additional information on filing discrimination complaints is available on the Non-Discrimination Policy and Language Access webpage.