Abortion (pregnancy termination) services do not require prior authorization of coverage by the health plan. The primary care physician, their physician group, or the Health Net Medi-Cal Member Services Department , Community Health Plan of Imperial Valley Member Services Department or CalViva Health Medi-Cal Member Services Department (for Fresno, Kings and Madera counties) can help identify an appropriate provider.

Abortions performed by participating and non-participating providers are the financial responsibility of the capitated participating physician group (PPG). PPG financial responsibility for non-participating providers is limited to the Medi-Cal fee-for-service (FFS) rate.

An abortion is classified as a sensitive service. Medi-Cal members may obtain an abortion from any qualified provider, in or out of plan, without obtaining a referral or prior authorization (unless the abortion is performed during an inpatient hospitalization). Members may also receive mifepristone (RU-486) in accordance with the Food and Drug Administration (FDA)-approved treatment regimen and other mandated requirements.

A Medi-Cal member seeking an abortion may self-refer or request a referral from her primary care physician (PCP). If asked for a referral, PCPs may direct members to an abortion provider within their participating physician group (PPG) but may not indicate in any manner that the member cannot seek services elsewhere. A qualified provider of abortion services is the member's PCP, an OB/GYN, certified nurse midwife, nurse practitioner, physician assistant, family planning clinic, or a federally qualified health center (FQHC).