MedicaidReimbursementMedium impact
23-1269m For Family Planning Services, Provider Augmented Reimbursement Now Based on Medi-Cal FFS Rate
Health Net·CA · Family Medicine, Internal Medicine, OB-GYN +1 more·Prior Authorization
Effective date
Aug 15, 2023
We identified it
Jun 20, 2026
Summary
Health Net has retired the augmented reimbursement rate for family planning services effective August 15, 2023. Non-contracted providers will now be paid the standard Medi-Cal fee-for-service base rate plus any applicable CMS-approved directed payments instead of the previously higher augmented rate.
Action Required
Immediately: Billing team must update fee schedules and expectations for family planning services with Health Net Medi-Cal in Fresno, Kings, and Madera counties. Remove augmented reimbursement rates from billing system and update to reflect standard Medi-Cal FFS base rates. Contact CalViva Health at 888-893-1569 for questions about specific reimbursement rates.