MedicaidAdministrativeHigh impact
26-1008a 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 25, 2026
Summary
Effective January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care plans to Medi-Cal Fee-for-Service (FFS). Providers must be enrolled in Medi-Cal FFS by the deadline to continue treating these members and receive reimbursement. Billing processes, claims submission, and authorization requirements will shift from managed care to FFS workflows.
Action Required
By January 1, 2027: (1) Billing team must verify current Medi-Cal FFS enrollment status for your practice; (2) If not enrolled, submit application through the PAVE (Provider Application and Validation for Enrollment) system immediately to meet the deadline; (3) Update billing system configuration to process UIS member claims through Medi-Cal FFS rather than managed care plans; (4) Modify prior authorization workflows to comply with Medi-Cal FFS requirements instead of managed care plan requirements; (5) Train billing and front desk staff on new eligibility verification procedures and FFS claims submission processes; (6) Review and update encounter forms to ensure providers document required information for FFS billing. Failure to complete FFS enrollment by January 1, 2027 will result in loss of reimbursement for services provided to UIS members after the transition date. Continue verifying member eligibility and enrollment status prior to rendering services to identify affected UIS members early.