California Medicare Savings Program Denial: How to Appeal

Read the Notice of Action First

When your parent's MSP application is denied — or their existing MSP benefits are terminated — the county sends a Notice of Action (NOA). This document matters. It contains the specific reason for the denial, the regulatory citation, the income or asset calculation the county used, and appeal instructions on the back page (called the "NA Back 9").

Before filing an appeal, check whether the denial was based on a factual error. Common mistakes include:

• Wrong income figure: The county counted income that doesn't apply (an adult child's income, for example, which is never deemed to a parent for MSP)
• Outdated asset limits: A worker applied the old federal floors ($9,430) instead of California's 2026 limit ($130,000)
• Failed to apply the $20 disregard: Gross income was compared to the limit without subtracting the mandatory $20 monthly deduction
• Incorrect household size: A couple was evaluated as two single individuals, or vice versa

If you spot an error, call the county eligibility worker directly. Many denials can be resolved at the county level without a formal hearing — the worker recalculates, corrects the case, and issues a new NOA.

Filing a State Hearing

If the county won't correct the error, or if you believe the denial is wrong for reasons the county disagrees with, you have the right to a State Hearing before an Administrative Law Judge (ALJ) at the California Department of Social Services (CDSS).

Deadline: 90 calendar days from the date the NOA was mailed. Not received — mailed. The date is printed on the notice.

Six ways to file:

1. Online: CDSS Appeals Case Management System at acms.dss.ca.gov
2. Phone: 1-800-743-8525 (TDD: 1-800-952-8349)
3. Fax: 1-833-281-0905
4. Email: [email protected]
5. Mail: CDSS State Hearings Division, P.O. Box 944243, MS 21-37, Sacramento, CA 94244-2430
6. In person: Drop off at your local county welfare office

You don't need a lawyer to file. State the facts: what program you applied for, why you believe you qualify, and what the NOA got wrong.

Aid Paid Pending: Keep Benefits While You Appeal

If the county is terminating existing MSP benefits (not a new application denial), you can request Aid Paid Pending — which keeps your parent's current benefits running unchanged until the ALJ decides the case.

The catch: to request Aid Paid Pending, file the hearing request on or before the effective date of the proposed action, or within 10 days of the NOA mailing date. Miss this window and benefits stop while the appeal is processed.

Aid Paid Pending is critical for a parent who is currently receiving QMB and facing termination. Without it, they lose Part B premium coverage and billing protections immediately, even if the county's decision is later overturned.

What to Bring to the Hearing

Organize evidence that directly addresses the NOA's stated reason for denial:

• Income documentation: Social Security award letter, pension statements, most recent bank statements showing income deposits
• Asset documentation: Bank statements for the current month, proof of exempt assets (home ownership, vehicle title, burial contracts)
• The NOA itself: Highlight the specific calculation or finding you're contesting
• Any correspondence: Copies of Form MC 355 responses, documents you submitted, county worker notes if available
• California regulatory citations: If the county applied the wrong standard (old asset limits, missing disregard), bring the current ACWDL or regulation showing the correct rule

The hearing is conducted by phone or in person. The ALJ reviews the evidence, asks questions, and issues a written decision.

Free Help With Appeals

You don't have to navigate this alone:

• HICAP (1-800-434-0222): Free Medicare counseling, including help with MSP applications, Part D enrollment, and billing disputes
• Legal Aid: Local legal services organizations (LAFLA, NLSLA, LSNC) represent low-income seniors in state hearings at no cost
• Area Agencies on Aging: Connect families with local advocacy resources

Our California Medicare Savings Programs & Extra Help Guide covers the appeal process from start to finish — including how to read the county's NOA calculation, evidence worksheets for building your case, and the exact Aid Paid Pending deadline rules.

See more California guides →