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07-29-2026 DHCS policy guide for transition of the unsatisfactory immigration status population from managed care to Medi-Cal fee-for-service – Version 1.0 IE LA SAC SD
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Aug 4, 2026
Summary
Effective January 1, 2027, Medi-Cal members with unsatisfactory immigration status (UIS) will transition from managed care plans to Medi-Cal Fee-for-Service (FFS). Providers must enroll in Medi-Cal FFS through DHCS to continue serving these patients and receive reimbursement. Billing workflows, care coordination processes, and prior authorization procedures will shift from managed care to FFS requirements.
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What to do
by Dec 31, 2026 · 10 steps
01Billing team must complete the following actions.
02Verify that your organization is enrolled in Medi-Cal FFS through DHCS Provider Enrollment Division (PED) via PAVE; if not enrolled, submit enrollment application immediately to meet the January 1, 2027 deadline.
03Update billing system configuration to process Medi-Cal FFS claims for transitioned members instead of managed care claims; configure system to use FFS billing requirements and billing codes.
04Audit and update all billing workflows, encounter forms, and prior authorization procedures to reflect FFS requirements rather than managed care plan requirements.
05Train billing staff on Medi-Cal FFS billing processes, including electronic and paper claim submission, Treatment Authorization Request (TAR) and eTAR procedures, and FFS rate schedules.
06Establish care coordination handoff procedures with colleagues to ensure continuity of care; coordinate member records transfer.
07Update member-facing materials and notifications to inform patients of the transition effective January 1, 2027.
08Configure billing system to bill eligible care management services using specified FFS CPT and HCPCS codes (98960-98962, G0019, G0022, 99424-99427, 99490-99491, 99437, 99439, G0506, 99366, 99368, G9012, 99484, 99492-99494, T1017, and CPSP codes) for reimbursement.
09Consequences: Failure to enroll in Medi-Cal FFS will result in claim denials and loss of reimbursement for services to transitioned members.
10Incorrect billing codes or non-compliance with FFS requirements will result in claim rejections.
Codes mentioned
989609896198962G0019G002259409596125962059840Z1032Z1034T1033T1032Z10389942499425994269942799490994919943799439G05069936699368G901299484994929949399494T1017Z6500Z6200Z6202Z6204Z6206Z6208S0197Z6300Z6302Z6304Z6306Z6308Z6400Z6402Z6404Z6406Z6408Z6410Z6412Z6414
Original notice
07-29-2026 DHCS policy guide for transition of the unsatisfactory immigration status population from managed care to Medi-Cal fee-for-service – Version 1.0 IE LA SAC SD
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Related changes
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Molina Healthcare policiesCA policy changesCode 98960Code 98961Code 98962Code G0019Code G0022Code 59409Code 59612Code 59620Code 59840Code Z1032Code Z1034Code T1033Code T1032Code Z1038Code 99424Code 99425Code 99426Code 99427Code 99490Code 99491Code 99437Code 99439Code G0506Code 99366Code 99368Code G9012Code 99484Code 99492Code 99493Code 99494Code T1017Code Z6500Code Z6200Code Z6202Code Z6204Code Z6206Code Z6208Code S0197Code Z6300Code Z6302Code Z6304Code Z6306Code Z6308Code Z6400Code Z6402Code Z6404Code Z6406Code Z6408Code Z6410Code Z6412Code Z6414