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Medi-CalMedicaid · Reimbursement · Claims & Billing · CAHigh impact

Justice-Involved (JI) Reentry Initiative: Medi-Cal Fee-for-Service Reimbursement Methodology

Act
immediately
Effective date
Jul 6, 2026
Identified
Jul 7, 2026

Summary

Medi-Cal clarifies that Justice-Involved (JI) pre-release services use standard fee-for-service reimbursement methodology with no separate JI billing structure. Providers must apply unit values, conversion factors, split billing rules for professional/technical components, timely filing penalties, and specific JI adjustments (Modifier QJ 10% bump offset by 1% W&I Code 14105.191 reduction) to calculate accurate reimbursement.

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What to do

immediately · 8 steps
01Billing team must implement the following changes in billing software and provider education.
02Configure reimbursement calculation logic to multiply unit value × conversion factor for base reimbursement.
03For split-billable services (Prof% values between 0.01-0.99), automatically apply Modifier 26 (professional) and Modifier TC (technical) splitting based on Prof% column from Medi-Cal Rates worksheet.
04Apply timely filing penalties: 75% reimbursement for claims 7-9 months late, 50% for 10-12 months late, denial after 12 months.
05For JI services, add Modifier QJ to apply 10% rate increase, then apply 1% reduction per W&I Code 14105.191 (net +9% adjustment).
06Train all billing staff on monthly Medi-Cal rate updates (effective 15th, published 16th) and require verification of current rates before claim submission.
07Establish mandatory workflow to check Medi-Cal Rates page and Notes to Rates documentation monthly.
08Update all claim templates and provider encounter forms to reflect correct coding requirements.
If missed: Failure to implement split billing will result in over/underpayment, incorrect JI modifier application will trigger payment discrepancies, and untimely filing will reduce reimbursement or deny claims entirely.

Codes mentioned

9938671045

Original notice

Justice-Involved (JI) Reentry Initiative: Medi-Cal Fee-for-Service Reimbursement Methodology
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.
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Related policy hubs

Medi-Cal policiesCA policy changesCode 99386Code 71045

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