You will still have a hearing before an Administrative Law Judge (hearing officer) through the Office of Administrative Hearings (OAH). If your disagreement was about a service under the Medi-Cal Home and Community-Based Waiver program,^[1]f the hearing officer was able to rule in your favor under the Lanterman Act and there were no questions under the Home and Community Based Services Waiver, the hearing officer’s decision is the … Continue reading it is only a “proposed” decision. The Lanterman Act says OAH must submit the decision to the Director of Health Care Services to review under federal Medicaid law. If the Director agrees with the hearing officer’s decision, it becomes, “adopted,” which means that decision is final. They will send you a copy of it. If the Director makes a new decision, they will send you a copy of the new decision.^[2]Section 4712.5(c)

Even though the Lanterman Act says it is the Director of Health Care Services that reviews decisions, the Lanterman Act also says they are allowed to give someone else that authority.^[3]Section 4712.7 In the DD Waiver, they give that authority back to the Office of Administrative Hearings.^[4]DD Waiver, January 2018, page 235 of 295 So, fair hearings under the DD Waiver are conducted by independent hearing officers with OAH. Then, the Director of DHCS, the State Medicaid Agency, has given the authority to adopt final decisions to the “Director of OAH.” If you disagree with the hearing officer’s decision, you should ask the Director of OAH to review that decision under federal Medicaid law and give you a final decision. The OAH Director’s contact information is here: https://www.dgs.ca.gov/OAH/Contact