This law section states that if someone disagrees with certain decisions about their child's eligibility for a health program, they can appeal the decision to the board. Specifically, they can challenge decisions regarding whether their child can join or stay in the program, whether their child can stay enrolled, and the start date of their child’s coverage. The appeal is valid if they believe these decisions go against the program's rules or policies that were explained to them by the program or board.

If you want to challenge a decision, you must file an appeal in writing within 60 days of the decision notice. Your appeal needs to include a copy of the decision or a description of the action you're contesting, a detailed list of the disputed issues, the laws or policies you believe were violated, the outcome you're seeking, and any other relevant information.

If an appeal doesn't state a specific law or policy violation, it will be treated differently under another section. If your appeal points out a violation but lacks other required details, it will be sent back. You can resubmit it within the original 60-day period or within 20 days after you get it back, whichever is later.

If someone files an appeal under Section 12693.85, they get an initial review. The review happens in two steps. First, the program checks if the problem needs fixing based on laws or official program policies. If yes, they fix it within 30 days and inform the person. If not, the person is also notified within 30 days and can then ask the executive director to look at it. This request must be in writing and follow specific guidelines.

The executive director may reach out for more details during their review and will give a written decision. If the person disagrees with this decision, they can request an administrative hearing within 30 days, explaining why they think the decision was wrong.

This law outlines an alternative process called 'program review' for reviewing program decisions when a subscriber or purchasing credit member is not eligible to appeal under another section. It's important to note that this review is separate from the formal appeals process and does not grant any additional appeal rights. If someone is unhappy with a decision from their health, vision, or dental plan, they must resolve it directly with the plan, not through program review. If an appeal involves requesting an administrative hearing, it will be handled according to a different section.

This law outlines how administrative hearings for appeals are handled by the Managed Risk Medical Insurance Board. It incorporates existing procedures from another regulation but with some changes specific to this context. References to agencies and organizations are adjusted to fit the Board, and specific timelines are extended, allowing more time for filing and decisions. The Board can decide cases themselves or have them reviewed with additional evidence by the original hearing officer. Decisions must be made within 90 days of the final hearing. Additionally, they have the option to use an Administrative Law Judge for hearings.