MedicaidReimbursementMedium impact
25-526 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 Medi-Cal capitation payment rates based on member birthdays, effective August 2025. Instead of applying age-based rate changes on the last day of the birth month, rates will now change based on the specific birth date - members born on the 1st get rate changes in their birth month, while those born after the 1st get changes the following month.
Action Required
Before August 2025: Billing team should review monthly capitation reports for affected Medi-Cal members and expect payment variations based on the new birth date methodology. No immediate action required as Health Net will automatically implement these changes with no retroactive adjustments.