26-1009 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS

Date: 08/19/26

Enroll in Medi-Cal Fee-for-Service by January 1, 2027, to continue treating affected members

Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care to Medi-Cal Fee-for-Service (FFS) on January 1, 2027. Providers who wish to continue treating affected UIS members and receive reimbursement for services provided after the transition must be enrolled in Medi-Cal FFS by January 1, 2027.

What you need to do

• Verify your Medi-Cal FFS enrollment status. Providers must be enrolled in Medi-Cal FFS to continue treating affected UIS members and receive reimbursement for services provided after January 1, 2027.
• Apply through the Provider Application and Validation for Enrollment (PAVE) system if you are not enrolled. Providers who are not currently enrolled through the PAVE system must apply and be approved by January 1, 2027, to receive reimbursement at FFS rates. For information about Medi-Cal FFS enrollment requirements and the PAVE application process, visit the Department of Health Care Services (DHCS) PAVE webpage.
• Prepare for Medi-Cal FFS billing requirements. Claims and any required authorizations will be processed through Medi-Cal FFS rather than a managed care plan.
• Support continuity of services for affected UIS members during the transition. Minimize disruptions in ongoing treatment and services whenever possible.

Provider impact

Providers treating affected UIS members will be required to follow Medi-Cal FFS requirements, including claims submission and any applicable authorization processes, for services provided on or after January 1, 2027.

For information about Medi-Cal FFS billing requirements and provider guidance, visit the Medi-Cal Provider Publications website.

Member impact

This change does not affect the eligibility of affected UIS members for Medi-Cal services. Affected UIS members will continue to have access to Medi-Cal benefits following the transition to Medi-Cal FFS.

Additional information

Updates will be provided as additional guidance becomes available from the DHCS. Providers can also visit the DHCS webpage about immigration status and changes to Medi-Cal eligibility for additional information about the transition and related program updates at Medi-Cal Changes Immigration Status.

Need help? Contact us

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569. Behavioral health providers can call 844-966-0298.
 

This information applies to Physicians and Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

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