MedicaidReimbursementMedium impact
26-718m Capitation Payments for Newborns: No Separate Payment Until Month 3
Health Net·CA · Pediatrics, Family Medicine, OB-GYN·Reimbursement
We identified it
Jun 20, 2026
Summary
For Medi-Cal newborns, providers must not request separate capitation payments during the first 2 months of life - 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 stop requesting separate capitation payments for newborns during month of birth and following month for Medi-Cal patients. Use mother's coverage and CIN for first 2 months. Starting month 3, switch to newborn's individual CIN for capitation payments. Update billing workflows to automatically apply mother's coverage for newborn services in first 2 months.