MedicaidReimbursementHigh impact
25-459 Reminder: Balance Billing Medi-Cal Members is Prohibited
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
This is a reminder that balance billing Medi-Cal members is strictly prohibited under state and federal law. Providers cannot charge Medi-Cal members any copayments, deductibles, coinsurance, or other fees for covered services, with the only exception being when a Medi-Cal share-of-cost must be met.
Action Required
Immediately: Billing team must ensure no Medi-Cal members are being charged copayments, deductibles, coinsurance, or any fees for covered services. Verify insurance coverage by asking members about multiple health plans during registration. When Medi-Cal is secondary insurance, do not charge the member's primary insurance cost-sharing amounts. Update billing procedures to bill fee-for-service Medi-Cal for members whose managed care coverage is on hold. Non-compliance may result in disciplinary action under the Provider Participation Agreement.