MedicaidReimbursementMedium impact
26-719m Capitation Payments for Newborns: No Separate Payment Until Month 3
Health Net·CA · OB-GYN, Pediatrics, Family Medicine·Reimbursement
We identified it
Jun 20, 2026
Summary
Providers must not request separate capitation payments for newborns during the first 2 months when the mother is enrolled in Medi-Cal. Newborns are covered under the mother's plan during birth month and following month, with separate payments beginning in month 3 using the newborn's individual CIN.
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. Beginning in month 3, switch to newborn's individual CIN for separate capitation payments. Update billing system rules to prevent incorrect newborn capitation requests during first 2 months.