MedicaidCoverageHigh impact
Important Update: One-Year Restriction on Federal Payments to “Prohibited Entities” Under H.R. 1 Section 71113 Ends Effective July 4, 2026
Medi-Cal·CA · OB-GYN, Family Medicine·Provider Bulletin
Effective date
Jul 4, 2026
We identified it
Jun 25, 2026
Summary
Effective July 4, 2026, the one-year federal payment restriction on 'Prohibited Entities' under H.R. 1 Section 71113 expires, allowing these entities to resume submitting Medi-Cal and Family PACT claims for services rendered on or after that date. For the transition period (July 4, 2025–July 3, 2026), DHCS will not penalize providers for non-submission of claims or lack of associated documentation.
Action Required
By July 4, 2026: Billing team must verify whether your practice is classified as a 'Prohibited Entity' under H.R. 1 Section 71113. If classified as such, resume normal claim submission procedures for all covered Medi-Cal and Family PACT services with dates of service on or after July 4, 2026. Update billing system rules to remove any blocks or restrictions that were implemented for the July 4, 2025–July 3, 2026 period. Ensure all staff are aware that claims for DOS after July 4, 2026 should be submitted without exception. Reference the September 17, 2025 DHCS News Alert for clarification on the previous restriction period if needed. Contact OFPStakeholder@dhcs.ca.gov for questions about entity classification or claim submission requirements.