MedicaidAdministrativeHigh impact
24-946m Balance Billing for Medi-Cal Members is Prohibited
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
CalViva Health reinforces that balance billing Medi-Cal members is strictly prohibited under state and federal law. Providers cannot charge copayments, deductibles, coinsurance, or any fees to Medi-Cal members for covered services, with violations subject to disciplinary action.
Action Required
Immediately: Billing team must ensure no Medi-Cal members are charged copayments, deductibles, coinsurance, or any fees for covered services. Update billing system rules to prevent balance billing for all CalViva Health Medi-Cal members in Fresno, Kings, and Madera counties. Train staff on prohibited practices including charging D-SNP members any amounts or billing differences between negotiated and usual fees. Non-compliance will result in disciplinary action per Provider Participation Agreement.