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MedicaidAdministrativeHigh impact

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

Molina Healthcare·CA·Medicaid
Effective date
Jan 1, 2027
We identified it
Aug 4, 2026
Days to comply
150 days

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.

Action Required

Before Jan 1, 2027
By December 31, 2026: Billing team must complete the following actions: (1) Verify 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. (2) Update 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. (3) Audit and update all billing workflows, encounter forms, and prior authorization procedures to reflect FFS requirements rather than managed care plan requirements. (4) Train 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. (5) Establish care coordination handoff procedures with colleagues to ensure continuity of care; coordinate member records transfer. (6) Update member-facing materials and notifications to inform patients of the transition effective January 1, 2027. (7) Configure 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. Consequences: Failure to enroll in Medi-Cal FFS will result in claim denials and loss of reimbursement for services to transitioned members. Incorrect billing codes or non-compliance with FFS requirements will result in claim rejections.

Affected Billing Codes

98960
98961
98962
G0019
G0022
59409
59612
59620
59840
Z1032
Z1034
T1033
T1032
Z1038
99424
99425
99426
99427
99490
99491
99437
99439
G0506
99366
99368
G9012
99484
99492
99493
99494
T1017
Z6500
Z6200
Z6202
Z6204
Z6206
Z6208
S0197
Z6300
Z6302
Z6304
Z6306
Z6308
Z6400
Z6402
Z6404
Z6406
Z6408
Z6410
Z6412
Z6414