Medicare AdvantageCoverageHigh impact
[California] Continuing Community Health Worker services following the UIS transition
Anthem BCBS·CA·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
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). Community Health Worker (CHW) providers must complete care coordination and member transitions before the deadline, then enroll in Medi-Cal FFS to continue serving these members and bill DHCS directly for services after the transition.
Action Required
Before January 1, 2027: CHW care providers and supervising organizations must (1) coordinate with members' PCPs and clinical/behavioral health/county/community partners to minimize service disruptions; (2) verify whether current care providers can continue serving members through Medi-Cal FFS; (3) identify alternative Medi-Cal FFS care providers when necessary; and (4) assess whether members may qualify for behavioral health services, home and community-based services, county programs, or other available supports. CHW providers must continue delivering and billing Anthem for CHW services through December 31, 2026. Starting January 1, 2027: CHW supervising care providers who want to continue serving transitioning members must confirm enrollment in Medi-Cal FFS and be prepared to submit claims to the Department of Health Care Services (DHCS) rather than Anthem. Providers not already enrolled in Medi-Cal FFS must complete enrollment through PAVE (Provider Application and Validation for Enrollment). Failure to complete transition planning and coordination before the deadline may result in service disruptions for members and loss of billing revenue after January 1, 2027.