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Unsatisfactory Immigration Status (UIS) Member Transition
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
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.
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What to do
by Jan 1, 2027 · 9 steps
01Billing 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/.
02If not enrolled, submit FFS enrollment application immediately to ensure approval by deadline.
03Billing team must update billing software to switch L.A.
04Care 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.
05Billing 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).
06Clinical team must review patient records and remind UIS members to refill prescriptions before January 1, 2027 to prevent disruption.
07Providers 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.
08Failure to enroll in Medi-Cal FFS by January 1, 2027 will result in claims being denied and inability to bill for UIS member services.
09Contact DHCS Telephone Service Center at (800) 541-5555 or (916) 636-1980 for enrollment and billing support.
Codes mentioned
989609896198962G0019G002259409596125962059840Z1032Z1034T1033T1032Z10389942499425994269942799490994919943799439G05069936699368G901299484994929949399494T1017Z6500Z6200Z6202Z6204Z6206Z6208S0197Z6300Z6302Z6304Z6306Z6308Z6400Z6402Z6404Z6406Z6408Z6410Z6412Z6414
Original notice
Unsatisfactory Immigration Status (UIS) Member Transition
lacare.org · Always check the source before changing claims.
Related policy hubs
L.A. Care Health Plan policiesCA policy changesCode 98960Code 98961Code 98962Code G0019Code G0022Code 59409Code 59612Code 59620Code 59840Code Z1032Code Z1034Code T1033Code T1032Code Z1038Code 99424Code 99425Code 99426Code 99427Code 99490Code 99491Code 99437Code 99439Code G0506Code 99366Code 99368Code G9012Code 99484Code 99492Code 99493Code 99494Code T1017Code Z6500Code Z6200Code Z6202Code Z6204Code Z6206Code Z6208Code S0197Code Z6300Code Z6302Code Z6304Code Z6306Code Z6308Code Z6400Code Z6402Code Z6404Code Z6406Code Z6408Code Z6410Code Z6412Code Z6414