What types of policy changes does Medi-Cal issue?

Medi-Cal regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Medi-Cal update its policies?

Medi-Cal typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Medi-Cal policy changes are tracked here?

This page currently tracks 26 documented Medi-Cal policy changes. New items are added as they are identified.

What should I do when Medi-Cal changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Medi-Cal Policy Changes & Prior Auth Updates

We track 26 documented policy changes from Medi-Cal across CA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Medi-Cal notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Medi-Cal updates automatically.

Medium impact
Justice-Involved (JI) Reentry Initiative: Telecommunications Modifier GQ is Reimbursable
Medi-Cal·Effective Oct 1, 2024
Medi-Cal now reimburses modifier GQ (asynchronous telecommunications/store-and-forward) for Justice-Involved (JI) reentry services provided by embedded and in-reach providers, including FQHCs and RHCs. This applies retroactively to October 1, 2024, and includes automatic reprocessing of previously denied claims.
Medium impact
Justice-Involved (JI) Reentry Initiative: Provider Types Updated for General and Care Management Services
Medi-Cal·Effective Oct 1, 2024
The Justice-Involved Reentry Initiative has updated which provider types can deliver general and care management services to justice-involved individuals in Medi-Cal. Several provider types including community clinics, optometrists, and pharmacists have been added, while others like physical therapists, occupational therapists, and speech therapists have been removed from eligibility.
Low impact
August 2026 Medi-Cal In-Person Training Event
Medi-Cal·Effective Aug 11, 2026
Medi-Cal is hosting a free in-person training event on August 11, 2026, in Santa Barbara offering billing courses and individual claims assistance. Registration is required by August 10, 2026, through the Medi-Cal Learning Portal.
Medium impact
New Requirement for Provider Verification in Telephone Service Center
Medi-Cal·Effective Aug 1, 2026
Starting August 1, 2026, providers calling the Telephone Service Center will need to verify their identity using their most recent checkwrite amount instead of previous verification methods. This permanent security enhancement affects all provider interactions requiring verification when contacting support.
Medium impact
Coming Soon: Transition of the Web-Based Medi-Cal Hospice Program Attestation Form to the Medi-Cal Provider Portal
Medi-Cal·Effective Sep 1, 2026
Starting September 1, 2026, Medi-Cal hospice providers must submit their Hospice Program Attestation Forms through the Medi-Cal Provider Portal instead of the current web-based system, which will be permanently shut down. Providers without portal access will be unable to submit required attestation forms.
Low impact
Medi-Cal Learning Portal System Update January 2026
Medi-Cal·Effective Jan 1, 2026
The Medi-Cal Learning Portal (MLP) has updated its registration and training requirements for providers offering Presumptive Eligibility (PE) services. Key changes include new registration requirements for county-contracted PE providers, consolidation of PE certification requirements to one per provider instead of per NPI, and replacement of email support with a new ticketing system.
Medium impact
FQHC or RHC Providers: Updates to Psychological Associate Services Billing and MFT CSOSR Requirements
Medi-Cal·Effective Jan 1, 2025
FQHCs and RHCs can now bill Medi-Cal PPS rates for psychological associate services when supervised by a licensed clinical psychologist, and no longer need to submit Change in Scope of Service Requests when adding Licensed Marriage and Family Therapists as billable practitioners.
Low impact
COVID-19 PHE Audits for Free-Standing Skilled Nursing Facilities
Medi-Cal·Identified May 31, 2026
California DHCS has published updated audit instructions for Medi-Cal COVID-19 public health emergency expenses at free-standing skilled nursing facilities. Providers must submit COVID-19 PHE Reporting Schedules for expenses and revenues from January 1-December 31, 2023 by August 15, 2026.
Low impact
Reminder: June 2026 Medi-Cal In-Person Training Event
Medi-Cal·Effective Jun 10, 2026
Medi-Cal is hosting an in-person training event on June 10, 2026, in Del Mar, CA, offering billing courses and individual Claims Assistance Room (CAR) support. Registration is required through the Medi-Cal Learning Portal by June 8, 2026, at 11:59 p.m.
Low impact
Justice-Involved (JI) Reentry Initiative: Enrollment Requirements and Procedures for CBOs
Medi-Cal·Effective Nov 25, 2024
California DHCS has established new Medi-Cal provider enrollment requirements for Community-Based Organizations (CBOs) providing Justice-Involved Reentry Initiative services. CBOs must now attest that their Community Health Workers meet specific qualifications and report detailed information about all staff providing JI services when billing Medi-Cal.
Medium impact
Audiology Billing Reminder
Medi-Cal·Effective May 14, 2026
Medi-Cal clarifies that audiologists receiving RAD Code 0008 denials (provider not eligible for services billed) should use the correct audiology billing codes and modifiers from the Audiology and Hearing Aids Provider Manual. Previous billing instruction changes for HIPAA-compliant codes have not been implemented yet.
High impact
Update for Select ICD-10-CM/PCS Codes for 2026
Medi-Cal·Effective Apr 1, 2026
CMS has added 83 new ICD-10-PCS procedure codes that became effective April 1, 2026. Healthcare practices must use these new codes for all visits and encounters occurring on or after April 1, 2026.
Low impact
New Mandatory Survey for Ground Emergency Medical Transportation Providers
Medi-Cal·Effective Jun 19, 2026
California ground emergency medical transportation providers must complete a mandatory Average Commercial Rate (ACR) survey by June 19, 2026. The Department of Health Care Services is hosting an informational webinar on May 29, 2026 to assist with completion.
High impact
Cell and Gene Therapy Access Model Update: UB-04 Claim Form is Required for Reimbursement of HCPCS Codes J3392 and J3394
Medi-Cal·Effective May 20, 2026
For Medi-Cal's Cell and Gene Therapy Access Model, providers must now use UB-04 claim forms (or 837I electronic) instead of CMS-1500 forms when billing HCPCS codes J3392 (Casgevy) and J3394 (Lyfgenia) for sickle cell disease treatment. Claims submitted on CMS-1500 forms will be denied.
Medium impact
2026-2027 Fiscal Year Two Week Fee-for-Service Checkwrite Hold
Medi-Cal·Effective Jun 18, 2026
Medi-Cal fee-for-service payments scheduled for June 18 and June 25, 2026 will be delayed until July 2, 2026 due to a fiscal year transition checkwrite hold. This affects Medi-Cal fee-for-service, Family PACT, CPE, and other state-funded programs but excludes Every Woman Counts Program.
Medium impact
Hospital Presumptive Eligibility Program Update
Medi-Cal·Effective May 28, 2026
Effective May 28, 2026, California's Hospital Presumptive Eligibility (HPE) program will no longer cover patients 65 and older, and adults aged 19-64 with Medicare Part A/B will be ineligible for the New Adult coverage group. Providers must use the updated HPE application form and cannot use previous versions.
High impact
Notification: DRG Payment System Update to Hospital-Acquired Condition V43.1 on April 1, 2026
Medi-Cal·Effective Apr 1, 2026
The DRG Payment System updated to Solventum version 43.1 Hospital-Acquired Condition (HAC) list effective April 1, 2026, incorporating new ICD-10 CM and PCS HAC codes from CMS. Claims submitted with old HAC codes for admissions on or after April 1, 2026 may be denied with specific RAD codes, and providers should include Present On Admission (POA) indicators to prevent claim delays.
Low impact
July 2026 Medi-Cal Provider Event: In-Person Claims Assistance Room
Medi-Cal·Effective Jul 22, 2026
Medi-Cal is launching in-person Claims Assistance Room (CAR) events starting July 22, 2026, in San Jose, CA, offering providers one-on-one billing support sessions. Providers can schedule 45-minute appointments with field representatives to get personalized help with complex billing issues and claim denials.
Medium impact
Dental MCP Reimbursement at the All-Inclusive Rate for Tribal Health Programs
Medi-Cal·Effective Jan 1, 2026
Effective immediately and retroactively to January 1, 2026, Dental Managed Care Plans must reimburse IHS-MOA clinics and Tribal FQHCs at the All-Inclusive Rate (AIR) for covered dental services when Medi-Cal members are enrolled in a Dental MCP. Providers must bill the member's assigned Dental MCP directly for reimbursement at the AIR rate.
Low impact
Justice-Involved (JI) Reentry Initiative: Trainings Scheduled for May and June 2026
Medi-Cal·Identified May 3, 2026
Medi-Cal is offering five training webinars in May and June 2026 for the Justice-Involved (JI) Reentry Initiative, covering billing procedures, behavioral health services, and claims processing for providers serving justice-involved populations. Providers must register through the Medi-Cal Learning Portal to attend.
Medium impact
Presumptive Eligibility Provider Update: 2026 FPL Programming Complete
Medi-Cal·Effective Mar 24, 2026
Medi-Cal has updated their Presumptive Eligibility systems with 2026 Federal Poverty Levels as of March 24, 2026. Providers can now request manual review of income-based denials that occurred between January 1-March 24, 2026, as these used outdated 2025 poverty levels.
Medium impact
Coming Soon: Important Policy Reminders and Clarifications for Covered Medi-Cal CHW Services
Medi-Cal·Identified May 3, 2026
California DHCS is updating the Medi-Cal Provider Manual to clarify billing requirements for Community Health Worker (CHW) preventive services, including individual and group billing procedures using specific CPT and HCPCS codes, and telehealth usage guidelines.
Medium impact
Temporary Solution for PE Confirmation Documents Printing Blank BIC Information in Provider Portal
Medi-Cal·Effective Apr 27, 2026
The Medi-Cal Provider Portal has a technical issue where Presumptive Eligibility (PE) confirmation documents are printing with blank Benefits Identification Card (BIC) numbers. Providers must verify all PE confirmation documents have complete information and contact specific DHCS programs via email or phone to obtain missing BIC numbers when needed.
Medium impact
Notice of Change for Provider Portal: Erroneous Payment Correction (EPC) Letters
Medi-Cal·Effective Apr 28, 2026
Medi-Cal is requiring providers to register for a Notice of Change regarding Erroneous Payment Correction (EPC) Letters through the Provider Portal. Providers must complete registration through the Medi-Cal Learning Portal web page to ensure enrollment and receive important updates about payment corrections.
Medium impact
Justice-Involved (JI) Reentry Initiative: New Course for Attestation Enhancement
Medi-Cal·Identified May 3, 2026
Medi-Cal is offering a new self-paced online training course titled 'Justice-Involved (JI) Reentry Initiative: Attestation Enhancement Notice of Change' through the Medi-Cal Learning Portal. Providers must register for the course and complete it to enhance their attestation requirements for serving justice-involved patients reentering the community.
Low impact
Justice-Involved (JI) Reentry Initiative: Provider Support Reminder
Medi-Cal·Effective Apr 30, 2026
Medi-Cal has issued a reminder about provider support resources for the Justice-Involved (JI) Reentry Initiative. Providers can contact the Telephone Service Center at 1-800-541-5555 for assistance with JI program inquiries, portal navigation, billing questions, and claim issues.

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Justice-Involved (JI) Reentry Initiative: Telecommunications Modifier GQ is Reimbursable

Justice-Involved (JI) Reentry Initiative: Provider Types Updated for General and Care Management Services

August 2026 Medi-Cal In-Person Training Event

New Requirement for Provider Verification in Telephone Service Center

Coming Soon: Transition of the Web-Based Medi-Cal Hospice Program Attestation Form to the Medi-Cal Provider Portal

Medi-Cal Learning Portal System Update January 2026

FQHC or RHC Providers: Updates to Psychological Associate Services Billing and MFT CSOSR Requirements

COVID-19 PHE Audits for Free-Standing Skilled Nursing Facilities

Reminder: June 2026 Medi-Cal In-Person Training Event

Justice-Involved (JI) Reentry Initiative: Enrollment Requirements and Procedures for CBOs

Audiology Billing Reminder

Update for Select ICD-10-CM/PCS Codes for 2026

New Mandatory Survey for Ground Emergency Medical Transportation Providers

Cell and Gene Therapy Access Model Update: UB-04 Claim Form is Required for Reimbursement of HCPCS Codes J3392 and J3394

2026-2027 Fiscal Year Two Week Fee-for-Service Checkwrite Hold

Hospital Presumptive Eligibility Program Update

Notification: DRG Payment System Update to Hospital-Acquired Condition V43.1 on April 1, 2026

July 2026 Medi-Cal Provider Event: In-Person Claims Assistance Room

Dental MCP Reimbursement at the All-Inclusive Rate for Tribal Health Programs

Justice-Involved (JI) Reentry Initiative: Trainings Scheduled for May and June 2026

Presumptive Eligibility Provider Update: 2026 FPL Programming Complete

Coming Soon: Important Policy Reminders and Clarifications for Covered Medi-Cal CHW Services

Temporary Solution for PE Confirmation Documents Printing Blank BIC Information in Provider Portal

Notice of Change for Provider Portal: Erroneous Payment Correction (EPC) Letters

Justice-Involved (JI) Reentry Initiative: New Course for Attestation Enhancement

Justice-Involved (JI) Reentry Initiative: Provider Support Reminder