MedicaidReimbursementMedium impact
25-528 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/CalViva Health is changing how Medi-Cal monthly capitation payments are calculated based on member birth dates. Starting August 2025, members born on the 1st will have new age-based rates applied in their birth month, while members born after the 1st will have rates applied the following month.
Action Required
Before August 2025: Billing team should review and understand the new capitation rate timing to anticipate changes in monthly capitation reports and payments. Monitor future capitation statements for affected members and contact Health Net Capitation Department via email for any questions about payment adjustments.