MedicaidAdministrativeHigh impact
Unsatisfactory Immigration Status (UIS) Member Transition
L.A. Care Health Plan·CA·Provider Communication
Effective date
Jan 1, 2027
We identified it
Aug 22, 2026
Summary
Effective January 1, 2027, L.A. Care Health Plan members with Unsatisfactory Immigration Status (UIS) will transition from Medi-Cal managed care to Medi-Cal Fee-for-Service (FFS). Providers must be enrolled in Medi-Cal FFS through PAVE by January 1, 2027 to continue serving these patients and receive reimbursement. Billing workflows must shift from managed care to FFS processes, and providers should familiarize themselves with FFS billing requirements, rates, and newly available care management billing codes.
Action Required
By January 1, 2027: (1) Billing team must verify provider enrollment in Medi-Cal FFS through PAVE (Provider Application and Validation for Enrollment) at https://www.dhcs.ca.gov/providers-partners/provider-application-and-validation-for-enrollment/. If not enrolled, submit FFS enrollment application immediately to ensure approval by deadline. (2) Billing team must update billing software to switch L.A. Care UIS member claims from managed care billing to Medi-Cal FFS billing processes, including claim submission method (paper or electronic via CA-MMIS) and authorization workflow. (3) Billing team must update billing codes library to include all available Medi-Cal FFS care management, case management, and community health worker codes (CPT 98960-98962, 99424-99427, 99437, 99439, 99490-99491, 99366, 99368, 99484, 99492-99494, and corresponding HCPCS codes G0019, G0022, G0506, T1017, Z-series, S0197). (4) Clinical team must review patient records and remind UIS members to refill prescriptions before January 1, 2027 to prevent disruption. (5) Providers must familiarize themselves with Medi-Cal FFS billing requirements, rate schedules, and Provider Manual at https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications. Failure to enroll in Medi-Cal FFS by January 1, 2027 will result in claims being denied and inability to bill for UIS member services. Contact DHCS Telephone Service Center at (800) 541-5555 or (916) 636-1980 for enrollment and billing support.