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L.A. Care Health PlanMedicaid · Administrative · Provider Communication · CAHigh impact

Unsatisfactory Immigration Status (UIS) Member Transition to Full Scope Medi-Cal Fee-for-Service

Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 15, 2026

Summary

Effective January 1, 2027, L.A. Care Health Plan members with unsatisfactory immigration status (UIS) will transition from L.A. Care managed care to California Medi-Cal Fee-for-Service (FFS). Providers must complete transition planning and care coordination by December 31, 2026, and enroll in Medi-Cal FFS by January 1, 2027 to continue serving these members. Enhanced Care Management, CICM, Community Supports, Complex Care Management, and Transitional Care Services will end for transitioned members, but Community Health Worker services will continue in Medi-Cal FFS.

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What to do

by Dec 31, 2026 · 10 steps
01Billing and care management teams must conduct transition planning and care coordination with all L.A.
02Care members with UIS, including verification that current providers can/will serve members in Medi-Cal FFS and identification of alternative providers if needed;.
03Current ECM, CICM, CCM, TCS, and CHW providers must transmit member assessments and care management plans to receiving Medi-Cal FFS providers and complete warm handoffs by this deadline.
04By January 1, 2027.
05Billing team must ensure provider enrollment in Medi-Cal FFS through the DHCS PAVE portal if the practice intends to serve transitioned members.
06Providers must be prepared to bill Medi-Cal FFS for eligible care management and CHW services using codes to be provided by DHCS.
07Note: L.A.
08Care will continue authorizing and paying for ECM, CICM, Community Supports, CCM, TCS, and CHW services through December 31, 2026.
09Receiving Medi-Cal FFS providers may begin billing starting January 1, 2027.
10Non-tribal FQHCs and RHCs cannot serve as CHW supervising providers in Medi-Cal FFS.

Original notice

Unsatisfactory Immigration Status (UIS) Member Transition to Full Scope Medi-Cal Fee-for-Service
lacare.org · Always check the source before changing claims.
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