MedicaidCoverageHigh impact
26-935 DHCS Confirms Expiration of the Temporary Federal Payment Restriction Under H.R. 1
Health Net·CA·Reimbursement
Effective date
Jul 4, 2026
We identified it
Aug 12, 2026
Summary
Effective July 4, 2026, the one-year federal payment restriction on certain Medi-Cal providers classified as prohibited entities under H.R. 1 has expired. Affected providers may now resume submitting claims and encounters for covered Medi-Cal services with dates of service on or after July 4, 2026, and claims will be processed through standard adjudication procedures. This supersedes previous guidance from provider update 25-1075.
Action Required
By July 4, 2026: Billing team must resume normal claims submission procedures for all affected Medi-Cal providers in the specified counties. Update billing system to process claims for dates of service on or after July 4, 2026 through standard adjudication workflows (remove any blocking logic from the prior restriction). Verify that provider records in the billing system no longer reflect the payment restriction status. Notify all affected providers (physicians, PPGs, hospitals, ancillary, CS, ECM, and behavioral health providers) that they may begin submitting claims. Archive or deprecate provider update 25-1075 from internal reference materials. Contact Health Net Provider Services if claims are not processing normally: Medi-Cal at 800-675-6110 or Behavioral Health at 844-966-0298. Failure to remove restrictions may result in delayed or denied claims for otherwise covered services.