MedicaidPrior AuthMedium impact
26-196 Updated ABA Medical Necessity Criteria for Medi-Cal, Effective April 20, 2026
Health Net·CA · Psychiatry·Prior Authorization
Effective date
Apr 20, 2026
We identified it
Jun 20, 2026
Summary
Health Net is replacing CASP criteria with new clinical policy CA.CP.BH.104 for ABA medical necessity determinations for Medi-Cal patients under 21, effective April 20, 2026. This change only affects Medi-Cal plans in specific California counties, while Commercial and Individual plans will continue using CASP criteria.
Action Required
Before April 20, 2026: Billing team must review new clinical policy CA.CP.BH.104 Applied Behavior Analysis (ABA) at Health Net's Medical Policies section and update prior authorization processes for ABA services for Medi-Cal patients under age 21 in affected California counties. Update documentation requirements per CA.CP.BH.105. Contact Health Net Provider Services at 800-675-6110 or behavioral health line at 844-966-0298 for clarification on new criteria.