Medi-Cal managed care appeal deadlines (2026, verified)
Medi-Cal managed-care appeal rules combine the federal Medicaid managed-care regulation (42 CFR Part 438) with DHCS All Plan Letter 21-011. The values below are the operative California implementation, quoted from the federal text and corroborated by the APL where noted.
Per Appealant’s verified payer-deadline database, every value on this page is quoted verbatim from a primary source — the governing federal or California regulation — with the source linked and its effective date shown (sources re-retrieved 2026-07-04).
Calendar, business, and working days are not interchangeable, and month-based windows are never converted to day counts. Source documents were re-retrieved and verified 2026-07-04.
What is the MCO appeal filing deadline for Medi-Cal managed care (California Medicaid MCO)?
60 calendar days, counted from date on adverse benefit determination notice. Verified verbatim by Appealant from the primary source — 42 CFR § 438.402(c)(2)(ii), effective 2016-07-01 — most recently re-retrieved 2026-07-04.
What is the continuation of benefits request deadline for Medi-Cal managed care (California Medicaid MCO)?
10 calendar days, counted from later of plan sending abd notice or intended effective date of action. Verified verbatim by Appealant from the primary source — 42 CFR § 438.420(a) ("timely files" definition), effective 2016-07-01 — most recently re-retrieved 2026-07-04.
What is the state fair hearing filing deadline for Medi-Cal managed care (California Medicaid MCO)?
120 calendar days, counted from date of notice of appeal resolution. Verified verbatim by Appealant from the primary source — 42 CFR § 438.408(f)(2) + DHCS APL 21-011, effective 2016-07-01 — most recently re-retrieved 2026-07-04.
Full rules table, with verbatim sources
| Rule | Value | Clock starts | Applies to | Verbatim source text |
|---|---|---|---|---|
| MCO appeal filing | 60 calendar days | date on adverse benefit determination notice | Provider deadline | an enrollee has 60 calendar days from the date on the adverse benefit determination notice in which to file a request for an appeal 42 CFR § 438.402(c)(2)(ii) (effective 2016-07-01) |
| MCO standard resolution | 30 calendar days | receipt of appeal | Payer / reviewer clock | the State must establish a timeframe that is no longer than 30 calendar days from the day the MCO, PIHP, or PAHP receives the appeal. 42 CFR § 438.408(b)(2) + DHCS APL 21-011 (effective 2016-07-01) |
| MCO expedited resolution | 72 hours | receipt of expedited appeal | Payer / reviewer clock | the State must establish a timeframe that is no longer than 72 hours after the MCO, PIHP, or PAHP receives the appeal. 42 CFR § 438.408(b)(3) (effective 2016-07-01) |
| MCO extension | 14 calendar days | original deadline | Payer / reviewer clock | The MCO, PIHP, or PAHP may extend the timeframes from paragraph (b) of this section by up to 14 calendar days if— 42 CFR § 438.408(c)(1) (effective 2016-07-01) |
| Continuation of benefits request | 10 calendar days | later of plan sending abd notice or intended effective date of action | Provider deadline | 'Timely files' means files for continuation of benefits on or before the later of the following: (i) Within 10 calendar days of the MCO, PIHP, or PAHP sending the notice of adverse benefit determination. (ii) The intended effective date of the MCO's, PIHP's, or PAHP's proposed adverse benefit determination. 42 CFR § 438.420(a) ("timely files" definition) (effective 2016-07-01) |
| Deemed exhaustion MCO timing failure | — (procedural rule, no numeric deadline) | — | Payer / reviewer clock | In the case of an MCO, PIHP, or PAHP that fails to adhere to the notice and timing requirements in § 438.408, the enrollee is deemed to have exhausted the MCO's, PIHP's, or PAHP's appeals process. 42 CFR § 438.402(c)(1)(i)(A) (effective 2016-07-01) |
| Standard authorization decision | 7 calendar days | receipt of service request | Payer / reviewer clock | may not exceed 7 calendar days after receiving the request 42 CFR § 438.210(d)(1)(i) (as amended by CMS-0057-F, 89 FR 8980) (effective 2026-01-01) |
| Expedited authorization decision | 72 hours | receipt of service request | Payer / reviewer clock | no later than 72 hours after receipt of the request for service 42 CFR § 438.210(d)(2)(i) (effective 2016-07-01) |
| State fair hearing filing | 120 calendar days | date of notice of appeal resolution | Provider deadline | The enrollee must have no less than 90 calendar days and no more than 120 calendar days from the date of the MCO's, PIHP's, or PAHP's notice of resolution to request a State fair hearing. 42 CFR § 438.408(f)(2) + DHCS APL 21-011 (effective 2016-07-01) |
| Advance notice termination reduction | 10 calendar days | counts backward from intended date of action | Payer / reviewer clock | The State or local agency must send a notice at least 10 days before the date of action, except as permitted under §§ 431.213 and 431.214. 42 CFR § 431.211 (via § 438.404(c)(1) cross-reference) (effective 2016-07-01) |