26-720m Capitation Payments for Newborns: No Separate Payment Until Month 3

Date: 05/29/26

What to do in the first 2 months to avoid incorrect capitation payment processing

Providers must not request separate capitation payments for newborns during the month of birth and the following month when the mother is enrolled in Medi-Cal.

During this period, the newborn is covered under the mother’s plan while the newborn’s individual coverage and Client Index Number (CIN) are being established.

Capitation payment starting in month 3

If the newborn remains enrolled in Medi-Cal after the second month:

• Use the newborn’s CIN.
• Separate capitation payments will begin based on the newborn’s individual enrollment.

Providers actions

• Do not request separate capitation payments during the first 2 months.
• Use the mother’s coverage during the month of birth and the following month.
• Use the newborn’s CIN beginning in month 3.
• Refer to the Medi-Cal Provider Operations Manual for newborn coverage capitation payment guidelines.

Have questions?

For questions about newborn capitation payments, contact Community Health Plan of Imperial Valley at 833-236-4141.

 

This information applies to Participating Physician Groups (PPGs), Physicians and Practitioners.

This information applies to Medi-Cal in Imperial County.