MedicaidAdministrativeMedium impact
25-1156 Change to PPG/PCP Assignment for Dual-Eligible non-D-SNP Members
Health Net·CA · Family Medicine, Internal Medicine, General Practice·Reimbursement
Effective date
Feb 1, 2026
We identified it
Jun 20, 2026
Summary
Effective February 1, 2026, dual-eligible members (Medi-Medi) not enrolled in D-SNP plans will no longer be assigned to Medi-Cal Participating Physician Groups (PPGs) in Imperial County. These members will be assigned to a placeholder PPG and instructed to see their Medicare providers instead, with Health Net paying claims secondary to Medicare coverage.
Action Required
Before January 1, 2026: Billing team should prepare for transition of dual-eligible non-D-SNP members away from PPG assignment. Continue using existing billing procedures during transition period as PPG contracted rates will still apply if members are assigned during transition. No immediate action required as PPGs will receive notification before January 1 and can continue providing care during transition.