MedicaidReimbursementMedium impact
25-527 Changes to Medi-Cal Monthly Capitation Payments Effective With August 2025 Capitation
Health Net·CA·Reimbursement
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net is changing how they calculate age-based Medi-Cal capitation rates effective August 2025. Instead of applying rate changes on the last day of a member's birth month, rates will now adjust based on the actual birth date within the month - members born on the 1st get rate changes that month, while members born after the 1st get changes the following month.
Action Required
Before August 2025: Billing team should review monthly capitation reports for changes in payment amounts for affected Medi-Cal members. No immediate system changes required as this is a payer-side adjustment. Monitor future capitation payments and contact Health Net Capitation Department via email if payment discrepancies are identified.