Unsatisfactory Immigration Status Member Transition to Medi-Cal Fee-for-Service
Overview for Providers
The California Department of Health Care Services (DHCS) will transition certain Medi-Cal members with Unsatisfactory Immigration Status (UIS) from Medi-Cal managed care to Medi-Cal fee-for-service (FFS), effective January 1, 2027.
This transition does not affect Medi-Cal eligibility. It changes how impacted members access care and services.
Key Milestones and Activities
| Date / Timeframe | Activity |
|---|---|
| August 2026 | Provider communications and transition support activities begin. |
| September 2026 | Additional operational guidance and data submission requirements are provided to provider groups, as applicable. |
| October 2026 | DHCS begins a text messaging campaign for impacted members. |
| December 1, 2026 | DHCS mails notices to impacted members. |
| January 1, 2027 | Impacted members transition to Medi-Cal FFS. |
Key Information
- Transition date: Impacted members will transition to Medi-Cal FFS on January 1, 2027.
- Coverage continues: Members who remain eligible for Medi-Cal will continue to receive coverage.
- Access to care: After the transition, members may receive services from providers who participate in Medi-Cal FFS.
- Provider participation: Providers who wish to continue caring for impacted members should review Medi-Cal FFS enrollment and billing requirements.
Recommended Actions
- Review Health Net and DHCS transition updates.
- Educate office staff about the transition and available member resources.
- Review Medi-Cal FFS enrollment and billing requirements if you plan to continue serving impacted members.
- Monitor Health Net communications for additional guidance and resources.
Provider Frequently Asked Questions
Why is this transition occurring?
A: Federal guidance requires California to transition Medi-Cal members with UIS from the managed care delivery system to Medi-Cal FFS.
Will impacted members lose Medi-Cal coverage?
A: No. The transition does not end Medi-Cal eligibility. It changes how affected members access care through Medi-Cal beginning January 1, 2027.
Some pregnant and postpartum members covered under Section 214 of the Children's Health Insurance Program Reauthorization Act (CHIPRA Section 214) may remain enrolled in managed care and may not be affected by this transition.
Can providers continue caring for impacted members?
A:Yes. Providers may continue caring for impacted members after January 1, 2027, by enrolling in Medi-Cal FFS, if not already enrolled, and complying with applicable Medi-Cal FFS enrollment, billing, and program requirements.
Claims for services provided to impacted members on or after January 1, 2027, should be submitted directly to DHCS through the Medi-Cal FFS claims payment process.
Providers are encouraged to review Medi-Cal FFS requirements in advance to help ensure continuity of care and minimize disruptions for impacted members.
Will Health Net share lists of impacted members with providers?
A: Health Net will follow DHCS guidance regarding member information sharing. Additional information will be provided as guidance becomes available.
Supporting Impacted Members
Providers can help impacted members prepare for the transition by encouraging them to:
- Keep their mailing address and contact information up to date.
- Review notices received from DHCS regarding the transition.
- Contact their county Medi-Cal office for eligibility questions or to update contact information.
- Contact Member Services with Plan-related questions before the transition date.
- Health Net: 800-675-6110
- CalViva Health: 888-893-1569
- Community Health Plan of Imperial Valley: 833-236-4141
- Access available DHCS resources for information about the transition.