MedicaidCoverageMedium impact
20-929 Give Timely Flu Shots to Help Keep Members Healthy
Health Net·CA · Family Medicine, Internal Medicine, General Practice +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net CalViva Health confirms that flu vaccines are covered without prior authorization or cost-sharing for Medi-Cal members in Fresno, Kings, and Madera counties. Delegated at-risk PPGs must cover flu vaccine costs even when members receive vaccines at out-of-network locations during COVID-19 emergency.
Action Required
Immediately: Billing team must ensure flu vaccine administration claims are submitted to Health Net or applicable PPG without prior authorization requirements. For pediatric patients, use Vaccines for Children program for free vaccines and bill only administration fees. Delegated PPGs must arrange coverage for out-of-network flu vaccines with costs deducted from capitation payments.