MedicaidReimbursementHigh impact
24-945m Balance Billing for Medi-Cal Members is Prohibited
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net prohibits all balance billing for Medi-Cal members, including copayments, deductibles, coinsurance, and fees for covered services. Providers must not charge members any amounts except required Medi-Cal share-of-cost, with violations subject to disciplinary action.
Action Required
Immediately: Billing team must update billing system to prevent any charges to Medi-Cal members including copayments, deductibles, coinsurance, or balance billing. Front desk staff must verify if patients have multiple insurance plans and ensure no member charges when Medi-Cal is secondary. Update encounter forms to alert staff that charging Medi-Cal members is prohibited and may result in disciplinary action.