MedicaidReimbursementHigh impact
26-934 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
A one-year federal payment restriction on certain Medi-Cal providers classified as prohibited entities under H.R. 1 has expired as of July 4, 2026. 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 25-1074.
Action Required
By July 4, 2026 (or immediately if past this date): Billing team must resume normal claims submission for all affected Medi-Cal providers. Remove any system-level blocks or manual hold procedures that were implemented to comply with the temporary federal payment restriction under H.R. 1. Update internal workflows and billing software to process Medi-Cal claims for these providers through standard claims adjudication procedures. Notify all affected providers (Physicians, Practitioners, PPGs, Hospitals, Ancillary Providers, CS Providers, ECM Providers, and Behavioral Health Providers) that the restriction has ended. For questions, contact Community Health Plan of Imperial Valley at 833-236-4141 or Behavioral Health at 844-966-0298. Failure to resume claims submission will delay member reimbursement and provider payments.