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26-1008 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 the deadline to continue treating these members and receive reimbursement. All claims and authorization processes for UIS members will shift from managed care plans to Medi-Cal FFS processing.
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What to do
by Jan 1, 2027 · 7 steps
01Billing team and providers must verify current Medi-Cal FFS enrollment status immediately.
02Any providers not currently enrolled in Medi-Cal FFS must apply through the PAVE (Provider Application and Validation for Enrollment) system and obtain approval before the deadline.
03Billing team must update billing system configuration to route all Medi-Cal UIS member claims to Medi-Cal FFS processing instead of managed care plans, including implementing FFS-specific claim submission and prior authorization requirements.
04Update encounter forms and internal workflows to reflect FFS billing requirements for UIS members.
05Front desk staff must verify member eligibility and enrollment status prior to rendering services to ensure continuity of care.
06Failure to complete FFS enrollment will result in claim denials and loss of reimbursement for services provided to UIS members after January 1, 2027.
07Contact Health Net Provider Services at 800-675-6110 for enrollment questions or assistance.
Original notice
26-1008 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 Authorization26-1009 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