MedicaidReimbursementHigh impact
25-458 Reminder: Balance Billing Medi-Cal Members is Prohibited
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
This policy reinforces that balance billing Medi-Cal members is strictly prohibited under state and federal law. Providers cannot charge Medi-Cal members any fees, copayments, deductibles, or coinsurance for covered services, and must bill fee-for-service Medi-Cal when managed care coverage is on hold.
Action Required
Immediately: Billing team must ensure no Medi-Cal members are charged copayments, deductibles, coinsurance, or fees for covered services. Verify during coverage checks if members have multiple insurance plans (Medicare or Commercial as primary with Medi-Cal secondary) and do not charge any member cost-sharing when Medi-Cal is involved. Update billing system rules to prevent balance billing. Violations may result in disciplinary action and penalties.