MedicaidAdministrativeMedium impact
25-1154 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
Starting February 1, 2026, dual-eligible members (Medi-Medi) who are not in D-SNP plans will no longer be assigned to Medi-Cal PPGs and will instead be assigned directly to Health Net Community Solutions. These members will be treated as fee-for-service Medi-Cal with Health Net paying secondary to Medicare coverage.
Action Required
Before January 1, 2026: Billing team should identify dual-eligible non-D-SNP members currently assigned to PPGs and prepare for reassignment notifications. Continue using existing billing procedures during transition as PPG contracted rates will still apply. Monitor for Health Net notifications regarding specific member reassignments occurring 1-2 months after dual-eligible status is identified.