MedicaidAdministrativeMedium impact
Provider Bulletin 03-07-2025 Upcoming Change to Medically Tailored Meals Referrals New Required Form IE LA SAC SD
Molina Healthcare·CA·Provider Bulletin
Effective date
Apr 6, 2025
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California is implementing Version 3 of the Medically Tailored Meals (MTM) referral form for Medi-Cal members, effective April 6, 2025. The new form requires specific clinical information to be processed, and referrals without this required information will not be processed.
Action Required
By April 6, 2025: Download Version 3 of the MTM referral form from molinahealthcare.com/providers/ca/medicaid/forms/fuf.aspx. Update workflows to use the new form for all Medically Tailored Meals referrals for Molina Medi-Cal members. Ensure all referrals include required clinical information as referrals without this information will not be processed.