Government Benefits Q&As

1. What should I do if I receive a Notice of Action stating my CalWORKS Cash Aid, Food Stamps, Medi-Cal, CAPI, IHSS, etc. have been cut-off, reduced or denied?

• If you have had your CalWORKs, Food Stamps, Medi-Cal, IHSS, or related benefits cut off or reduced, or you have been denied benefits, request a hearing immediately.
• Do not wait to get an appointment with LAFLA. Read the notice informing you of the county’s action to see how long you have to appeal. The notice explains your rights. File your appeal before your time expires. Keep a copy of the request for hearing for your records.
• For the above benefits, you can continue to get benefits throughout the hearing process, if you request a hearing before the date that the county’s action is set to take place. This date can be found on the notice. Usually, you have ten days from the date on the notice to request a hearing to get continuing benefits.
• If you do not appeal in time to get aid throughout the appeal process, you may still appeal within ninety days of receiving the notice of action informing you of the county’s action. State law presumes that you received a notice five days after the date on the notice. However, you will not receive benefits while you go through the appeal process, if you request a hearing after the county’s action takes place.
• In making a decision about whether to request continuing benefits, remember that you will be charged with an overpayment if you lose at hearing.

To make an appointment, call (800) 399-4529. If you already have a hearing date, please let the receptionist know.

2. How can I make a case complaint to my DPSS district office if my CalWORKS Cash Aid, Food Stamps, Medi-Cal, IHSS, etc. have been cut-off, reduced or my application has been denied?

• If your CalWORKS, Food Stamps, Medi-Cal, or IHSS benefits have been denied, cut off, or reduced, you should complain immediately to the Department of Public Social Services Welfare office that handles your case. If you have tried talking to your eligibility worker about your problem and it is still not resolved, you should ask to speak with the deputy director of your worker’s unit and place a case complaint. You can ask your worker or your worker’s supervisor for the deputy director’s name and telephone number.
• If you cannot resolve your problem by speaking with your worker, your worker’s supervisor or the deputy director, you can call the DPSS Central Help line at (877) 481-1044.
• Take the name of everyone you speak to and also note the date and time you speak with them. Keep notes of all your conversations with DPSS workers and officials.

If you cannot resolve your problem by making a case complaint, call LAFLA at (213) 640-3901 to make an appointment.

If you already have a hearing date, be sure to tell the person at LAFLA who makes your appointment. Do this before you explain your problem.

3. How can I appeal Social Security Retirement, SSI, SSDI, Survivors and Medicare Reductions, Denials, or Terminations?

• Social Security appeals regarding the above benefits must be filed at your local Social Security office within sixty days of the day that you received the notice informing you of the Social Security action you. Federal law presumes that you received the notice five days of the date on the notice.
• However, in the case of a reduction or termination, you may continue receiving benefits until the resolution of the appeal, if you file within ten days of the date of the notice. You have to specifically ask for your benefits to be continued. Again, federal law presumes that you received the notice five days after the date on the notice.

4. Can I file a late appeal if my Social Security Retirement, SSI, SSDI or Medicare benefits are cut-off, reduced or denied?

• If you have missed the deadline for filing, there are good causes for filing a late appeal. Examples of good cause include being in the hospital or otherwise physically incapable of requesting an appeal in time. You must state your reason in writing and submit it with your request for appeal. You can go to your local Social Security office to get the form for showing good cause.
• Be sure to keep a copy of the appeal you filed at the Social Security office with a date stamp or receipt.

5. What should I do if I am denied Medi-Cal or I am cut-off of Medi- Cal?

There are several ways you can get or keep Medi-Cal if you have been told that you will not get Medi-Cal or you will lose it. Three things you can do are:

• Call the welfare office and make a case complaint
• File for a Fair Hearing
• Reapply for Medi-Cal

Medi-Cal Case Complaint

• The first thing you should do is speak with your eligibility worker and say that you have a case complaint. If you cannot reach your eligibility worker, or if your eligibility worker refuses to give you Medi-Cal, then go "up the chain of command." Tell your eligibility worker’s supervisor that you have a case complaint.
• If the supervisor does not help you, then call the deputy director. You can get the deputy director’s telephone number by asking your worker or by calling the general information number for your welfare district office. The deputy director is supposed to call you back within two hours and discuss your case.
• If you have been unable to successfully resolve your case compliant after you have tried to reach your eligibility worker, your eligibility worker’s supervisor, and the deputy director, then call LAFLA’s Government Benefit’s Unit intake number (213) 640-3901 for an appointment.

Medi-Cal Fair Hearing

• You have a right to ask for a Fair hearing if you are told your Medi-Cal will be taken away or that you cannot receive Medi-Cal. The welfare office is supposed to send you a letter (called a Notice of Action) telling you why you cannot get Medi-Cal.
• Look carefully at your Notice of Action to check what date it says your Medi-Cal will be discontinued.
• If you are receiving Medi-Cal already but are being cut off, make sure you ask for a Fair Hearing before the date that you lose your Medi-Cal. If you ask for a hearing before you Medi-Cal is taken away, you are entitled to "Aid Paid Pending" meaning that you will continue to receive Medi-Cal until a decision is made in your hearing. If you do not request a hearing before the date your Medi-Cal is to be cut off, you can still request a hearing up to 90 days from the date of your notice, but you will not get benefits while you wait for your hearing.

There are two ways you can file for a Fair Hearing: Call (800) 952-5253 or
Write to: Appeals and State Hearings Section
P.O. Box 18890
Los Angeles, CA 90018

If you write to ask for a hearing, you can use the back of any Notices of Action you have received.

Re-apply for Medi-Cal
It is often a good idea to both appeal the termination of your Medi-Cal and reapply for it.

6. How can I disenroll in my Medi-Cal HMO?

• If you are enrolled in a health plan because you receive Medi-Cal, you may have the right to disenroll with certain restrictions if you are not satisfied with the health plan you are in.
• If you want to disenroll from the health plan, you must request a disenrollment form from Health Care Options (HCO) at (800) 430-4263. HCO will send you a disenrollment form which you must fill out and return. Usually, it will take between 15-45 days after you send in your disenrollment form for you to be disenrolled from the health plan. There are certain cases in which you can disenroll more quickly (called "expedited disenrollment").
• If you have tried calling the numbers listed and are still having problems disenrolling, call LAFLA at (213) 640-3901 to make an appointment.

7. How can I make a complaint if I am having problems enrolling in a Medi-Cal plan?

• Health Care Options (HCO) also takes complaints when you are having problems enrolling in a plan. For instance, if you asked to be enrolled in a health plan, but you have not received any information about your enrollment, you can call HCO for information at (800) 430-4263.
• If you have already called HCO and you are still having problems with your health plan, you may call the Office of the Ombudsman at (888) 452-8609, which is part of the State Department of Health Services. The Ombudsman will investigate and try to resolve your complaints about the care you receive through the health plan and will try to help if you are having problems with HCO in getting disenrolled from the health plan. You can also call the Health Consumer Center for assistance at (800) 896-3203.
• If you have tried calling the numbers listed and are still having problems enrolling, call LAFLA at (213) 640-3901 to make an appointment.

8. How can I get free and low cost health services?

• If you need medical services, they are available at public and private clinics, hospitals and other locations and may be provided at low or no cost depending on your income. These services are provided on an ability-to- pay basis. For information on where to get free or low cost health services call (800) 427-8700.

9. How can I get free or low-cost health insurance for my children?

• If you do not have health insurance or free (no share of cost) Medi-Cal to cover the medical needs of your children (up to age 19), the Healthy Families program provides low-cost health insurance for those who qualify. Health Families offers several plans to choose from. For more information about the program or to get an application you can call (888) 747-1222 or call the Los Angeles County and Nutrition Hotline at (800) 597-4777.

10. What can I do if I have a General Relief problem?

• If you have a General Relief problem, please call (213) 640-3918 Monday through Friday from 9:00 a.m. to 5:00 p.m.

11. How can I appeal a General Relief Case?

• If the County decides to reduce or terminate your General Relief benefits, the county must provide you with a hearing before a county employee not involved in the original decision affecting your benefits.
• The County must send a notice of action, providing you with the date and time of your hearing at least nine days before the hearing date. At the hearing you will have the opportunity to explain why you are still eligible for benefits.