MedicaidReimbursementMedium impact
25-912 Critical Update: How New Federal Restrictions May Affect Your Medi-Cal Payments
Health Net·CA · OB-GYN, Family Medicine·Reimbursement
Effective date
Jul 4, 2025
We identified it
Jun 20, 2026
Summary
New federal law H.R. 1 temporarily restricts Medi-Cal payments to certain reproductive health providers (Prohibited Entities) for one year, with some exceptions for abortion-related services and court injunction protections. Billing teams must identify affected providers and follow specific claim submission requirements for different service types.
Action Required
Immediately: Billing teams must identify if their practice meets Prohibited Entity criteria (nonprofit family planning/reproductive health provider with >$800K Medicaid payments in FY2023 that provides abortion services). If affected without court relief, submit abortion-related claims separately using only codes 59840, 59841, 59850-59852, 59855-59857, S0190, S0191, S0199 with directly related ancillary care only. Continue normal billing for all other Medi-Cal providers and services provided before July 4, 2025.