25-528 Changes to Medi-Cal Monthly Capitation Payments Effective With August 2025 Capitation

Date: 05/28/25

Age-based rate adjustments aligned with member birth month

To align with the Department of Health Care Services (DHCS) monthly capitation payment guidelines Health Net, on behalf of CalViva Health, is implementing a change to our monthly Medi-Cal capitation payment process to ensure that accurate, age-based capitation rates are applied.

Key changes

Historically, the member’s capitation rate was calculated based on their age on the last day of their birth month.

Example: A member born in the month of June, regardless of the day in June, has their updated rate applied in June.

Beginning with your August 2025 monthly capitation, payments will be adjusted based on a member’s birth date within the month. See examples below.

How the adjustment works

For members born on the 1st of the month

The new age-based capitation rate will take effect during the same month as their birthday.

Example: A member born on April 1 will have their updated rate applied in April.

For members born after the 1st of the month

The new age-based capitation rate will take effect in the following month after their birthday.

Example: A member born on April 2 will have their updated rate applied starting May 1.

Why this matters

This change ensures our payment practices adhere to DHCS guidelines and payment methodology while applying accurate, age-based capitation rates.

What to expect

You may notice changes to future monthly capitation reports and payments for affected members. Note that there will be no retroactive adjustments or recoupments for past payments.

Additional information

If you have any questions about these changes or adjustments to your monthly capitation payments, please contact the Health Net Capitation Department via email. For all other questions contact the CalViva Health Provider Services Center at 888-893-1569.
 

This information applies to Participating Physician Groups (PPGs) and Hospitals.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

 

Keep Your Info Updated & Access Key Resources Easily

Update your contact details quickly using our online form: Demographic Update Forms. This ensures members can connect with you easily or select you as a provider. Looking for important resources? Visit the Provider Library for your operations manual, forms, communications and more - all searchable and printable for your convenience!