MedicaidReimbursementMedium impact
26-720m Capitation Payments for Newborns: No Separate Payment Until Month 3
Health Net·CA · Pediatrics, OB-GYN, Family Medicine·Reimbursement
We identified it
Jun 20, 2026
Summary
For Medi-Cal newborns in Imperial County, providers must not request separate capitation payments during the first 2 months after birth - newborns are covered under the mother's plan during this period. Starting in month 3, use the newborn's individual Client Index Number (CIN) for separate capitation payments.
Action Required
Immediately: Billing team must update Medi-Cal capitation payment processes for Imperial County newborns. Do not request separate capitation payments during month of birth and following month - use mother's coverage and CIN during first 2 months. Beginning in month 3, switch to newborn's individual CIN for separate capitation payments. Update billing system rules to prevent incorrect capitation requests during first 2 months.