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This is a Non-Federal dataset covered by different Terms of Use than Data.gov.

Insurance Affordability Programs Eligibility Appeals

Metadata Updated: July 23, 2025

This dataset includes the number of individuals who have filed an appeal for a subsidized Covered California Qualified Health Plan (QHP), Medi-Cal, or a combination of both eligibility determinations by year and quarter. Appeals may be filed by an appellant for determinations that resulted in a denial, eligibility, or discontinuance of coverage. A denial is defined as an eligibility determination at application that resulted in a denial of coverage. An appeal regarding an eligibility determination may be filed when the appellant disputes the type of program eligibility. A discontinuance is when an individual is no longer eligible for Medi-Cal or Covered California QHP. Appeals may be filed for cases involving mixed determinations, such as when household members applied for and/or had eligibility determinations made for the two programs (i.e., parents were eligible for Covered California and the child(ren) were eligible for Medi-Cal). Covered California and Medi-Cal eligibility appeals are processed and adjudicated by Administrative Law Judges and the California Department of Social Services (CDSS) staff who track appeals and hearing results. This dataset is part of the public reporting requirements set forth in California Welfare and Institutions Code 14102.5(a)(6).

Access & Use Information

Public: This dataset is intended for public access and use. Non-Federal: This dataset is covered by different Terms of Use than Data.gov. License: See this page for license information.

Downloads & Resources

Dates

Metadata Created Date November 11, 2023
Metadata Updated Date July 23, 2025

Metadata Source

Harvested from State of California

Additional Metadata

Resource Type Dataset
Metadata Created Date November 11, 2023
Metadata Updated Date July 23, 2025
Publisher California Department of Health Care Services
Maintainer
Identifier 0b1be039-21cf-447f-9c53-88610dfbf99d
Data First Published 2017-06-16T22:17:25.454433
Data Last Modified 2025-06-30T22:18:36.615840
Category Health and Human Services
Public Access Level public
Metadata Context https://project-open-data.cio.gov/v1.1/schema/catalog.jsonld
Schema Version https://project-open-data.cio.gov/v1.1/schema
Catalog Describedby https://project-open-data.cio.gov/v1.1/schema/catalog.json
Harvest Object Id 007086b1-bf00-4b4b-8872-c1b11612c7ab
Harvest Source Id 3ba8a0c1-5dc2-4897-940f-81922d3cf8bc
Harvest Source Title State of California
License http://www.opendefinition.org/licenses/cc-by
Source Datajson Identifier True
Source Hash d4bcb69dcb16a8b505bb660a62c5e2ea50baf9aa1b8becf2c6df87c5b1d29ef1
Source Schema Version 1.1

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