Pregnancy Termination
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Certain different rules of confidential treatment, coverage and selection of providers apply to the sensitive services of family planning services, sexually transmitted disease (STD) treatment, abortion (pregnancy termination), and human immunodeficiency virus (HIV) testing as follows:
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).