Managed Care in California Series, Issue 4: Internal Grievances and External Review

Executive Summary

Federal and state law and the state and federal constitutions require that beneficiaries in Medi-Cal managed care plans receive notice, and grievance and appeal rights when they are denied access to medically necessary services. Frequently, however, enrollees fail to receive the required notice, get an inadequate notice, or do not understand their right to appeal the plan’s decision. This issue brief will provide an overview of the rules and processes that apply to all Medi-Cal plans, as well as the additional protections that apply to DMHC-licensed plans. (This issue brief was updated in August 2017.)

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