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26-1009 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 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.
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What to do
by Jan 1, 2027 · 5 steps
01Billing team must verify current Medi-Cal FFS enrollment status for the practice.
02If not enrolled, submit application through the PAVE (Provider Application and Validation for Enrollment) system immediately—approval must be completed before the effective date.
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.
05Notify providers treating UIS members of the transition to prevent service disruptions.
If missed: 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.
Original notice
26-1009 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 Authorization26-1010 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFSHighEffective Jan 1, 2027 · Prior AuthorizationBrowse every Health Net change in the policy list