MedicaidAdministrativeHigh impact
24-947m Balance Billing for 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 by federal and state law. Providers cannot charge Medi-Cal members any copayments, deductibles, coinsurance, or fees for covered services, and violations may result in 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 Community Health Plan of Imperial Valley Medi-Cal members. Train staff to verify if patients have multiple insurance plans and bill fee-for-service Medi-Cal when managed care coverage is on hold. Non-compliance will result in disciplinary action per Provider Participation Agreement.