MedicaidCoverageHigh impact
07-01-2026 Medi-Cal Enrollment Restrictions IE LA SAC SD
Molina Healthcare·CA·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 7, 2026
Summary
Molina Healthcare of California is notifying providers about Medi-Cal enrollment restrictions affecting members in six counties (Riverside, San Bernardino, Los Angeles, Sacramento, San Diego, and IE) who have failed to complete annual redetermination. Members with 'Hold Restrictions' are temporarily ineligible for non-emergency services. Providers must verify eligibility through AVES or Availity, support members in completing redetermination, and understand that retroactive coverage applies only if redetermination is completed within 90 days of termination.
Action Required
Immediately: (1) Billing/front desk staff must update eligibility verification procedures to check for 'Hold Restriction' status in AVES or Availity Essentials portal before scheduling or billing non-emergency services for Medi-Cal members in affected counties (Riverside, San Bernardino, Los Angeles, Sacramento, San Diego). (2) Train all staff to identify members with Hold Restrictions and inform them they are not eligible for non-emergency care until redetermination is complete. (3) Create process to assist members in contacting their county Medi-Cal office and submitting required redetermination documentation. (4) Implement tracking system to note the 90-day retroactive coverage window—if member completes redetermination within 90 days, coverage is retroactive to termination date; after 90 days, no retroactive coverage applies and member must reapply. (5) Do NOT bill non-emergency services for members with active Hold Restrictions; claims will be denied. (6) Verify county of member residence, as re-enrollment rules differ if member has relocated to a different county. Consequence: Claims for non-emergency services rendered to members with Hold Restrictions will be denied, requiring rebilling or write-off.