Medicare AdvantageAdministrativeHigh impact
08-04-2026 Provider Bulletin Summary IM IE LA OC SAC SD
Molina Healthcare·CA·Provider Bulletin
We identified it
Aug 18, 2026
Summary
Molina Healthcare of California issued a provider bulletin summarizing seven policy updates effective between July 20-31, 2026, across multiple service lines (Medi-Cal, Medicare Advantage, and Marketplace). Key changes include: a new Learning Management System for Medi-Cal providers, mandatory Medicare Advantage Model of Care training by December 31, 2026, transition of unsatisfactory immigration status members from managed care to Fee-for-Service effective January 1, 2027, Home Health Notice of Admission (NOA) compliance requirements effective November 1, 2026, updated Enhanced Care Management reimbursement rates effective October 1, 2026, and Community Supports policy/subcontractor documentation due August 18, 2026.
Action Required
MULTIPLE DEADLINES AND ACTIONS REQUIRED:
1. BY AUGUST 18, 2026 (Community Supports Providers): Submit complete list of subcontractors and all Community Supports policies and procedures to Molina. Going forward, report all changes to subcontractor lists and new CS policies/procedures within one month of occurrence. Failure to comply may result in service suspension.
2. BY SEPTEMBER 30, 2026 (Home Health Providers): Ensure Notice of Admission (NOA) submission process complies with CMS guidelines. Beginning November 1, 2026, any home health claims submitted without timely NOA documentation will be denied or adjusted. Billing team must update claims submission workflows to verify NOA submission within five calendar days of care start date.
3. BY DECEMBER 31, 2026 (Medicare Advantage Providers): All network providers involved in Medicare Advantage Special Needs Plan care must complete 2026 Model of Care training and submit signed attestation form. Obtain training materials and attestation forms from respective Molina websites. Non-completion may result in contract sanctions.
4. EFFECTIVE OCTOBER 1, 2026 (ECM/CS Providers): Enhanced Care Management reimbursement rates are changing. Billing team must update fee schedules in billing software and verify rates with Molina to ensure accurate claim submission and payment reconciliation.
5. EFFECTIVE JANUARY 1, 2027 (All Primary Care, Specialists, Behavioral Health, ECM/CS): Medi-Cal members with unsatisfactory immigration status will transition from Molina managed care to Fee-for-Service (FFS). Providers must: enroll through PAVE system to continue serving and receiving reimbursement; prepare billing systems for FFS claims (different coding/billing requirements); coordinate care handoffs with member notifications; encourage members to refill prescriptions before 1/1/27. Failure to enroll in PAVE will prevent reimbursement for services provided to transitioned members.
6. ONGOING: Billing team must monitor Molina provider website for Q3 training opportunities and ensure appropriate staff complete relevant training for their service line. Register providers on Molina website.
7. ONGOING: Subscribe to email notifications via Qualtrices form (link provided in bulletin) to receive future Provider Bulletins biweekly every other Tuesday.