Covered California Certified Enroller Practice Exam

Which agency serves as the designated appeals entity for Covered California and Medi-Cal?

1. California Department of Health Care Services (DHCS)

2. California Department of Social Services (CDSS)

3. California Insurance Department

4. California Health Benefit Exchange

The correct answer is: California Department of Social Services (CDSS)

The California Department of Social Services (CDSS) serves as the designated appeals entity for Covered California and Medi-Cal. This agency is responsible for overseeing various programs related to social services, including the administration of Medi-Cal and other health programs. When individuals seek to appeal decisions related to their health coverage through Medi-Cal or Covered California, CDSS is the correct point of contact for processing those appeals. The other agencies listed, while involved in health services and insurance regulation, do not function as the appeals entity for these specific programs. The California Department of Health Care Services (DHCS) is primarily focused on the administration of Medi-Cal but does not handle appeals directly. The California Insurance Department regulates insurance companies and policies in California but does not specifically address appeals related to health coverage in these contexts. The California Health Benefit Exchange, while overseeing the marketplace for health plans, also does not serve as the appeals body. Therefore, CDSS's role is vital in ensuring that individuals can challenge and seek resolution on decisions impacting their healthcare coverage.