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[California] Important notice for PCPs serving UIS members transitioning to Medi-Cal FFS
Effective date
Jan 1, 2027
Identified
Oct 27, 2026
Summary
Effective January 1, 2027, members with unsatisfactory immigration status (UIS) will transition from Anthem Medi-Cal Managed Care to Medi-Cal Fee-for-Service (FFS). PCPs who wish to continue treating these members must confirm enrollment in Medi-Cal FFS and billing capabilities. Referral authorization will continue through December 31, 2026, with DHCS preferring referrals for ongoing or post-transition services be directed to dual-enrolled Anthem Medi-Cal Managed Care/FFS providers.
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What to do
Action · 7 steps
01Before January 1, 2027.
02Billing team and clinical staff should identify patients with UIS currently enrolled in Anthem Medi-Cal Managed Care.
03PCPs must confirm enrollment as Medi-Cal FFS providers via PAVE (https://tinyurl.com/y8zws8ad) and verify ability to submit Medi-Cal FFS claims to DHCS.
04Billing team should review Medi-Cal FFS billing procedures, Treatment Authorization Request requirements, and fee schedules using provided resources (https://tinyurl.com/hfxsy75v and https://tinyurl.com/wpxu7x8b).
05Clinical staff should counsel transitioning members to keep scheduled appointments and obtain medication refills before the transition date.
06For services starting after October 1, 2026 and continuing post-January 1, 2027, or starting January 1, 2027, direct referrals made between October 1 and December 31, 2026 to Medi-Cal Managed Care providers with Anthem who are also enrolled in Medi-Cal FFS, when possible.
07PCPs not continuing care for UIS members must ensure appropriate patient handoff and record transfer to continuing provider.
If missed: Failure to confirm FFS enrollment and billing capability will result in inability to bill and receive reimbursement for these members after the transition date.
Original notice
[California] Important notice for PCPs serving UIS members transitioning to Medi-Cal FFS
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[California] TCS care providers: UIS member transition to Medi-Cal FFSHighEffective Jan 1, 2027 · Provider Bulletin[California] Continuing Community Health Worker services following the UIS transitionHighEffective Jan 1, 2027 · Provider Bulletin[California] UIS resident coverage transition to Medi-Cal FFSMediumEffective Jan 1, 2027 · Provider Bulletin[California] Important information regarding UIS transition to Medi-Cal Fee-for-ServiceHighEffective Jan 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list