MedicaidAdministrativeHigh impact
26-1010 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2027
We identified it
Aug 20, 2026
Summary
Effective January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care to Medi-Cal Fee-for-Service (FFS). Providers must enroll in Medi-Cal FFS through the PAVE system by this date to continue treating affected UIS members and receive reimbursement. All billing, claims submission, and prior authorization processes will shift from managed care plans to Medi-Cal FFS starting January 1, 2027.
Action Required
By January 1, 2027: (1) Billing team must verify current Medi-Cal FFS enrollment status in the PAVE system. (2) If not enrolled, apply immediately through PAVE at the DHCS website and obtain approval before the deadline. (3) Update billing software and workflows to process all UIS member claims through Medi-Cal FFS rather than managed care plans, including any required prior authorization processes. (4) Train billing and clinical staff on Medi-Cal FFS billing requirements and claims submission procedures. (5) Update provider contracts and member communications to reflect the transition. Providers who fail to enroll in Medi-Cal FFS by January 1, 2027 will not receive reimbursement for services provided to affected UIS members after that date. Contact Community Health Plan of Imperial Valley at 833-236-4141 (or 844-966-0298 for behavioral health) with questions.