MedicaidAdministrativeHigh impact
26-1009 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 be enrolled in Medi-Cal FFS by this date to continue treating these members and receive reimbursement. All billing, claims, and authorization processes will shift from managed care plans to Medi-Cal FFS requirements.
Action Required
By January 1, 2027: (1) Billing team must verify current Medi-Cal FFS enrollment status for the practice. (2) If not enrolled, submit application through the PAVE (Provider Application and Validation for Enrollment) system immediately—approval must be completed before the effective date. (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) Notify providers treating UIS members of the transition to prevent service disruptions. Failure to enroll in Medi-Cal FFS will result in inability to receive reimbursement for services provided to affected UIS members after January 1, 2027.