MedicaidDocumentationHigh impact
26-750 CalAIM PHM Update: New Requirements for Pregnancy Care, IHAs and Care Coordination
Health Net·CA · OB-GYN, Family Medicine, Internal Medicine·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
California's Medi-Cal program is implementing new care coordination and documentation requirements for pregnancy/postpartum care, with immediate response obligations starting now and mandatory comprehensive risk assessments beginning July 1, 2026. Providers must respond promptly to plan outreach, send discharge information via fax, and prepare for intensified care coordination documentation.
Action Required
Immediately through June 30, 2026: 1) Respond promptly to all Community Health Plan outreach for pregnancy/postpartum support and care coordination. 2) Send all discharge information and medication details via fax to 844-989-1935 (do not mail). 3) Complete and document all follow-up visits, especially postpartum and primary care, and be prepared to share visit information when requested. 4) Submit Initial Health Assessment (IHA) results within 90 days of member enrollment. 5) Document all IHA exceptions when using prior records or exemption criteria. By July 1, 2026: Implement comprehensive risk assessment tools meeting ACOG/CPSP standards for all pregnant/postpartum patients at early prenatal visits, each trimester, and postpartum visits. Develop individualized care plans including obstetric, nutrition, psychosocial and health education interventions. Ensure all pregnancy/postpartum patients receive moderate or high-intensity care coordination only.