CA AB617

Establishes an appeals process for eligibility and enrollment determinations for individuals applying through the California Health Benefit Exchange, administered by the State Department of Social Services.

Requires the Exchange to provide a combined eligibility notice informing applicants of their eligibility for Medi-Cal, CHIP, premium tax credits, cost-sharing reductions, and qualified health plans, with full details about appeal rights.

Allows applicants and enrollees to appeal within 90 days of an eligibility determination, with options for expedited appeals (5-day decision) and an informal resolution process before formal hearings.

Guarantees appellant rights including representation by counsel, de novo case review, hearings conducted by impartial officials, and decisions issued within 90 days based exclusively on applicable laws and provided information.

Requires continued eligibility for advance premium tax credits and cost-sharing reductions at previous levels while appeals are pending, and preserves right to federal appeals or judicial review.