MedicaidAdministrativeHigh impact
Medi-Cal Fee-for-Service Transition for UIS Members
Medi-Cal·CA·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Sep 12, 2026
Summary
Beginning January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care to fee-for-service Medi-Cal. Providers must enroll in Medi-Cal fee-for-service billing, update PAVE enrollment, and comply with fee-for-service billing requirements including Treatment Authorization Requests (TARs) to continue serving these members after December 31, 2026.
Action Required
By December 31, 2026: Billing team must complete the following actions: (1) Verify provider enrollment in Medi-Cal fee-for-service through PAVE system—providers enrolled only in managed care will lose billing access for UIS members after this date; (2) Confirm all enrollment, screening, and revalidation requirements are current in PAVE; (3) Review and implement fee-for-service billing requirements, including Treatment Authorization Request (TAR) processes; (4) Update internal billing software and workflows to process Medi-Cal fee-for-service claims instead of managed care claims for UIS members; (5) Update capacity information in provider directories to reflect acceptance of new fee-for-service UIS members. Failure to complete enrollment in Medi-Cal fee-for-service will result in inability to bill for and receive reimbursement for services provided to UIS members starting January 1, 2027. Coordinate with DHCS technical assistance resources and attend available tutorials through the Medi-Cal Learning Portal.