MedicaidReimbursementHigh impact
Provider Bulletin 05-02-2025 Targeted Rate Increase: Fee-for-Service Providers Frequently Asked Questions IE LA SAC SD
Molina Healthcare·CA · Family Medicine, Internal Medicine, General Practice +3 more·Provider Bulletin
Effective date
Jan 1, 2024
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California has implemented a targeted rate increase (TRI) for Medi-Cal providers offering primary care, obstetric, and non-specialty mental health services. Claims from January-April 2025 will be retroactively adjusted to TRI rates, and starting May 2025, TRI rates will be processed prospectively.
Action Required
Immediately: Review all Molina Medi-Cal claims from January 2024 forward to verify TRI rate adjustments. Monitor EOPs for 'Targeted Rate Increase Fee Schedule Adjustment' remarks. Billing team should expect retroactive adjustments through claims adjustment system for January-April 2025 dates of service. Starting May 2025, verify that primary care, obstetric, and non-specialty mental health claims are being paid at TRI rates prospectively. Reference the DHCS TRI Fee Schedule at dhcs.ca.gov for specific procedure codes eligible for increases.