26-749 CalAIM PHM Update: New Requirements for Pregnancy Care, IHAs and Care Coordination
Date: 06/15/26
What you must do now and what changes July 1, 2026
The Department of Health Care Services (DHCS) released updates to the Population Health Management (PHM) Policy Guide (January 2026). These updates expand requirements for care coordination, documentation and follow-up, with a strong focus on pregnancy and postpartum care, Initial Health Appointments (IHAs) and high-risk member management.
What this means for you
These updates change how you coordinate care, document services and share information.
- You will need to respond to Plan outreach and coordinate care more consistently.
- You will need to send discharge and follow-up information more quickly.
- Starting July 1, pregnant and postpartum patients must be managed under higher levels of care coordination.
- Expect more requests for documentation, risk data and care coordination support.
What you must do now (through June 30, 2026)
Take these steps now to stay compliant:
1 Respond when we contact you.
Includes pregnancy/postpartum support, discharge follow-up and care coordination.
2 Send discharge information promptly.
Include discharge instructions and medication details. Do not mail records. Fax records to 844-989-1935.
3 Complete and document follow-up visits.
- Focus on postpartum and primary care visits.
- Be prepared to share visit information when requested.
4 Submit IHA results on time.
Within 90 days of member enrollment when used for screening compliance.
5 Document IHA exceptions.
- Required when using prior records (within 12 months) or exemption criteria.
- Documentation must support the exception.
What changes July 1, 2026
Big picture: Care coordination becomes more structured and required, especially for pregnancy and postpartum care
A comprehensive risk assessment tool must be completed for all pregnant and postpartum members. The assessment must be comparable to the American College of Obstetricians and Gynecologists (ACOG) standard and Comprehensive Perinatal Services Program (CPSP) standards. Assessment results must be kept as part of the member record. The risk assessment tool must be administered at an early prenatal visit, once each trimester thereafter and at the postpartum visit. If administration of the risk assessment tool is missed at the appropriate timeframes, contact Provider Services at 888-893-1569 for help with completing it.
Note, the existing California Prenatal Screening (PNS) Program offers non-invasive, prenatal screening via cell-free DNA and maternal serum alpha-fetoprotein blood tests to pregnant members. Member participation in the PNS Program is voluntary, and you must document the member’s consent to participate. For more information on the screening tests available to pregnant members, refer to the PNS Program webpage and the Medi-Cal Provider Manual: Genetic Counseling and Screening section.
An individualized care plan must be developed to include obstetric, nutrition, psychosocial and health education interventions. The care plan must also provide appropriate follow-ups and referrals when indicated by identified risk factors.
Pregnancy and postpartum care (transitional care services)
- All patients must be in moderate or high-intensity care coordination.
- Lower-level (less intensive) support will no longer be allowed.
What you will need to do more consistently
- Support discharge planning.
- Reconcile medications after transitions of care.
- Share clinical information with the Plan in a timely manner.
Care coordination model updates
- High-intensity: Assigned care manager and required follow-up after discharge.
- Moderate-intensity: May include provider-led coordination with Plan support.
New requirement: Birthing supports checklist
For all pregnant and postpartum patients, you must help connect patients to medical care, behavioral health and social supports.
Requirements that remain in place
IHA
- Complete within 120 days of enrollment.
- Submit within 90 days to count toward screening compliance.
- May be completed across multiple visits.
- Telehealth allowed for some components.
IHA exemption
- Allowed if prior records are complete and within 12 months.
- Must be documented.
Risk stratification and high-risk members
- A statewide risk model is being implemented in 2026.
- Plans may use internal models during the transition.
What to expect
- More requests for risk information.
- More coordination for high-risk patients.
Local care coordination and partnerships
- The Plan will align with local community health priorities.
What this means for you
- More opportunities to coordinate with the Plan and community-based organizations.
Key changes at a glance
Requirement | Now − June 30, 2026 | Starting July 1, 2026 |
|---|---|---|
Discharge information | Required | Required with faster turnaround |
Pregnancy/postpartum care coordination | Current approach | Must be moderate or high intensity
|
Birthing supports checklist | Not required | Required |
Care coordination expectations | Increasing | Standardized and expanded |
Access the full policy guide
Download the DHCS 2026 PHM Policy Guide (PDF).
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), and Behavioral Health Providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.