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Insurance Affordability Programs Eligibility Appeals Hearing Results
This dataset includes the hearing results for eligibility appeals filed for subsidized Covered California coverage, Medi-Cal, or a combination of both eligibility determinations by year and quarter. The Department of Health Care Services (DHCS) assigns responsibility for conducting fair hearing requests (appeals) to the California Department of Social Services (CDSS). CDSS receives appeal requests, conducts hearings through their statewide network of administrative law judges, and renders decisions. CDSS provides these services to DHCS through a contract called an interagency agreement. In addition to the interagency agreement, the Delegation Order gives an Administrative Law Judge the authority to review and adopt decisions for hearings. Hearing requests (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). Hearings are held when an appeal filed by an appellant for determinations that resulted in a denial, eligibility, or discontinuance of coverage. This dataset provides categories of hearing results and includes granted, granted in part, denied, or withdrawn/dismissed. This dataset is part of the public reporting requirements set forth in the California Welfare and Institutions Code 14102.5(a)(6).
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Insurance Affordability Programs Eligibility Appeals
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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).
Applications Received For Insurance Affordability Programs Through Other Eligibility Pathways
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The number of Insurance Affordability Programs (IAPs) applications received through other eligibility pathways. Other eligibility pathways include applications transferred through transition from Advanced Premium Tax Credits (APTC) to Medi-Cal, as well as applications submitted through Hospital Presumptive Eligibility (HPE), through Express Lane, or the Medi-Cal Access Program (MCAP) during a reporting period. APTC to Medi-Cal batch data is reported by CalHEERS and MEDS and consists of individuals who are no longer eligible for APTC but are eligible for Medi-Cal. Another eligibility pathway is Express Lane Eligibility (ELE), which is a program that waives the need for a Medi-Cal eligibility determination for 12 months if the individual is enrolled in CalFresh. Hospital Presumptive Eligibility (HPE) applications are submitted through qualified HPE Providers. ELE and HPE data are reported by DHCS and commencing with this report, MCAP applications are reported by MAXIMUS Inc. This dataset is part of public reporting requirements of set forth in the California Welfare and Institutions Code 14102.5.
Newly Eligible Individuals by Insurance Affordability Program (IAP)
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This dataset includes the total number of newly eligible individuals by Insurance Affordability Program (IAP), by reporting period. IAPs include Medi-Cal, Covered California subsidized and unsubsidized Qualified Health Plans (QHP), and the Medi-Cal Access Program (MCAP). Covered California subsidized and unsubsidized QHP newly eligible data includes those who selected and enrolled in a QHP, and paid their first premium. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
Newly Eligible Individuals by Insurance Affordability Program (IAP)
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This dataset includes the total number of newly eligible individuals by Insurance Affordability Program (IAP), by reporting period. IAPs include Medi-Cal, Covered California subsidized and unsubsidized Qualified Health Plans (QHP), and the Medi-Cal Access Program (MCAP). Covered California subsidized and unsubsidized QHP newly eligible data includes those who selected and enrolled in a QHP, and paid their first premium. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
Eligible Individuals Enrolled in Medicare Savings Programs (MSP)
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The datasets include the monthly count of individuals who are enrolled in Medicare Savings Programs (MSP), by aid code and county. The counts reflect the total number of eligible individuals enrolled during the month. MSP help individuals with limited income and resources pay for some of the out-of-pocket costs for Medicare, including Medicare Part A and Part B premiums, deductibles, copayments, and coinsurance. There are four Medicare Savings Programs: Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Working Disabled Individual (QWDI). Individuals who are eligible for QMB, SLMB, and QI also automatically qualify for the Low Income Subsidy (or “Extra Help”) program, which helps lower the cost of prescription drugs. Counties and aid codes with zero individuals enrolled during a reporting period are not included in the dataset.
Eligible Individuals Enrolled in Medi-Cal Managed Care COHS Health Plans
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This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care County Organized Health System (COHS) Health Plans by reporting period. COHS is a Medi-Cal managed care health plan model that operates in 22 California counties. Each COHS is created by a county board of supervisors and governed by an independent commission. In COHS counties, a single plan serves all Medi-Cal beneficiaries enrolled in managed care. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
Newly Eligible Individuals enrolled in Medi-Cal Managed Care Health Plans
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This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care Health Plans by type of enrollment by reporting period. Medi-Cal Managed Care program contracts for health care services through established networks of organized systems of care emphasizing primary and preventive care. Newly eligible Medi-Cal beneficiaries must choose a Managed Care health plan within 30 days of Medi-Cal enrollment, or they will be enrolled in a Managed Care health plan by default. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
Sample 2025 Iowa Affordable Care Act Premiums County Explorer
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This explorer provides sample premium information for individual ACA-compliant health insurance plans available to Iowans for 2025.
Eligible Individuals Enrolled in Medi-Cal Managed Care COHS Health Plans
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This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care County Organized Health System (COHS) Health Plans by reporting period. COHS is a Medi-Cal managed care health plan model that operates in 22 California counties. Each COHS is created by a county board of supervisors and governed by an independent commission. In COHS counties, a single plan serves all Medi-Cal beneficiaries enrolled in managed care. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
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