MedicaidAdministrativeHigh impact
26-1008 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 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.
Action Required
By January 1, 2027: (1) Billing team and providers must verify current Medi-Cal FFS enrollment status immediately. (2) Any 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. (3) Billing 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. (4) Update encounter forms and internal workflows to reflect FFS billing requirements for UIS members. (5) Front desk staff must verify member eligibility and enrollment status prior to rendering services to ensure continuity of care. Failure to complete FFS enrollment will result in claim denials and loss of reimbursement for services provided to UIS members after January 1, 2027. Contact Health Net Provider Services at 800-675-6110 for enrollment questions or assistance.