MedicaidCoverageMedium impact
Provider Bulletin 11-26-2025 2025 CA Signed Legislations IM IE LA OC SAC SD
Molina Healthcare·CA·Provider Bulletin
Effective date
Sep 26, 2025
We identified it
Jun 19, 2026
Summary
Molina Healthcare California has implemented multiple legislative changes affecting Medi-Cal and Marketplace plans, including expanded coverage for reproductive health services, behavioral health protections, and new provider credentialing requirements. Key changes include prohibition of prior authorization for certain high-approval services and expanded coverage for hearing aids, insulin, and alternative birth centers.
Action Required
By January 1, 2026: Billing team must update systems to process claims for alternative birth centers without CPSP provider requirements. By January 1, 2027: Update copay limits for insulin to maximum $35 for 30-day supply in Marketplace plans. By January 1, 2028: Subscribe to and use current CAQH credentialing forms for provider credentialing processes. Monitor prior authorization exemption list publication by July 1, 2027 for services approved 90%+ of the time.