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26-1010 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
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.
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What to do
by Jan 1, 2027 · 7 steps
01Billing team must verify current Medi-Cal FFS enrollment status in the PAVE system.
02If not enrolled, apply immediately through PAVE at the DHCS website and obtain approval before the deadline.
03Update 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.
04Train billing and clinical staff on Medi-Cal FFS billing requirements and claims submission procedures.
05Update provider contracts and member communications to reflect the transition.
06Providers 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.
07Contact Community Health Plan of Imperial Valley at 833-236-4141 (or 844-966-0298 for behavioral health) with questions.
Original notice
26-1010 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
See all Health Net changes →26-1008a Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFSHighEffective Jan 1, 2027 · Prior Authorization26-1008 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFSHighEffective Jan 1, 2027 · Prior Authorization26-1009 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFSHighEffective Jan 1, 2027 · Prior AuthorizationBrowse every Health Net change in the policy list