MedicaidAdministrativeMedium impact
25-1155 Change to PPG/PCP Assignment for Dual-Eligible non-D-SNP Members
Health Net·CA·Reimbursement
Effective date
Feb 1, 2026
We identified it
Jun 20, 2026
Summary
Effective February 1, 2026, dual-eligible non-D-SNP members will no longer be assigned to Medi-Cal PPGs and will instead be assigned directly to CalViva Health with a placeholder PPG, allowing them to see their Medicare providers. This streamlines care coordination by making Medicare the primary payer with Medi-Cal as secondary.
Action Required
No immediate action required for billing teams. Continue using existing billing procedures for dual-eligible non-D-SNP members during the transition period. PPG contracted rates will still apply if members are assigned to a PPG during transition. Monitor for member assignment changes starting February 1, 2026.