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Medi-Cal Renewal Process

Help Members Keep their Medi-Cal Coverage

Overview

The Annual Eligibility Redetermination (AER), also known as the Medi-Cal Renewal Process, is currently underway across our state. This initiative is the biggest challenge facing the Medi-Cal program in its history. 

 

The impact on providers across the entire health care system will be significant, potentially resulting in:

  • Increased use of the emergency department for primary care
  • Decreased capacity of bed availability
    • Delays in hospital discharges while awaiting coverage
    • Increased length of stay for patients with delayed preventative or chronic care
  • Increased cost of care
  • Interruptions of ongoing care

Additional Medi-Cal Policy Impact in 2026 - 2027

 

Significant policy changes will continue to affect IEHP members with Unsatisfactory Immigration Status (UIS) through 2027. The impact on providers who may experience the loss of UIS members being removed from Primary Care Provider (PCP) panel assignments can lead to :

  • Lower capitation payments
  • Lower targeted rate increase (TRI) payments
  • Lower qualifying Global Quality Pay for Performance payments
  • Specialists and Ancillary providers may see a potential decrease in referral volume 

 

However, with every challenge comes opportunities to help our collective health care mission and partnership grow even stronger.

 

IEHP takes this challenge seriously, and we are committed to helping all members keep their Medi-Cal coverage, and our provider network keep their assigned members.

 

To review the latest statements made by IEHP Chief Executive Officer Jarrod McNaughton, regarding 2026 and 2027 Medi-Cal eligibility changes, please see the following communication:

 

2026 - 2027 Medi-Cal Policy Changes

Important Reminders - Members Transitioning to DHCS Medi-Cal Fee-for-Service (FFS)

Effective January 1, 2027, IEHP members with Unsatisfactory Immigration Status (UIS) will transition from IEHP-managed Medi-Cal coverage to the DHCS Medi-Cal Fee-for-Service (FFS) program. While eligible members will continue to receive Medi-Cal benefits, services will no longer be administered through IEHP and will be covered directly through the DHCS Medi-Cal FFS delivery system. Providers should be aware that member eligibility, billing processes, and care coordination will be impacted by this transition. Timely renewal of Medi-Cal coverage is important for affected members, as eligibility requirements have changed and may affect continued coverage.  

 

The Department of Health Care Services (DHCS) has published a detailed eligibility and coverage comparison chart to help providers and members better understand the upcoming changes. 

 

To view the chart mentioned and related updates, please visit the following:

 

To support a smooth transition for providers and members, DHCS is providing the following important information regarding provider enrollment, billing, and ongoing care responsibilities. 

This is a change in how people get care, not whether they have Medi-Cal. Coverage is not being lost. DHCS Medi-Cal FFS does not mean members pay. Medi-Cal still covers the cost of care. Medi-Cal members will not have to pay a co-pay or fee when they see a doctor, go to a clinic, or pick up a prescription.

 

Who’s Impacted 

  • These changes apply to Medi-Cal members who are:
    • Undocumented. 
    • Some lawful permanent residents (green card holders) in the five-year waiting period before they qualify for full-scope federally funded Medicaid.
    • People considered Permanently Residing Under Color of Law (PRUCOL), meaning they are allowed to stay in the U.S. even without a formal immigration status. 

 

What Members Need to Do 

  • Ask their current doctors and clinics if they accept DHCS Medi-Cal FFS. The Find Doctors and Services online tool will be updated in September 2026 with more user-friendly features to make it easier for members to find providers, and it will continue to be improved throughout the transition.
  • Keep contact information updated in the Medi-Cal system online or through their county office. 
  • Watch for mail from Medi-Cal about the change. 
  • Use their Medi-Cal Beneficiary Identification Card (BIC). New BICs will not be sent for this transition. Replacement BICs can be requested from county offices or BenefitsCal. 
  • Renew Medi-Cal on time to stay covered. 
  • Members can call the Medi-Cal Help Line 1-800-541-5555 for help understanding the change or finding DHCS Medi-Cal FFS providers.

What’s Changing

  • Members will not be in a Medi-Cal health plan. In DHCS Medi-Cal FFS, they may see any doctor, clinic, or hospital that accepts DHCS Medi-Cal FFS.

 

  • Enhanced Care Management and Community Supports are not available in DHCS Medi-Cal FFS.
    • Enhanced Care Management: Comprehensive care management for people with complex health or social needs.
    • Community Supports: Non-medical services such as housing navigation and medically tailored meals.
  • Members may still receive support in DHCS Medi-Cal FFS, such as chronic care management, doula services, and Community Health Worker services that provide health education, navigation support, renewal support, and help connecting to resources.
  • Beginning in January 2027, DHCS will add new coordination and navigation services for members transitioning to DHCS Medi-Cal FFS, including a Nurse Advice Line and clinic and community-based navigators who can help members understand benefits and find DHCS Medi-Cal FFS providers.

 

What’s Not Changing

  • Medicines will still be covered by Medi-Cal Rx.
  • Specialty mental health and substance use disorder treatment will continue through County Behavioral Health Plans.
  • Non-specialty mental health services such as therapy, counseling, medication follow-up, and psychological testing, will continue in DHCS Medi-Cal FFS. Members can get these services from any DHCS Medi-Cal FFS provider who offers them.
  • Primary care, specialty care, and hospital care benefits remain the same. Members can get these services from any clinic, doctor, or hospital that accepts DHCS Medi-Cal FFS.
  • Dental benefits remain the same for most members, though delivery differs by county:
    • Sacramento and Los Angeles counties will continue Dental Managed Care. (Enrollment in Los Angeles is voluntary) 
    • San Mateo County’s Dental Managed Care pilot ends December 31, 2026; members will move to Dental FFS on January 1, 2027. 
    • All other counties will continue using Dental FFS. 
    • Starting July 1, 2027, some adults will shift from full-scope dental services to emergency-only dental coverage. 
  • Members enrolled in the Program of All-Inclusive Care for the Elderly (PACE), which provides coordinated care for eligible older adults, will remain in PACE. 
  • Home and community-based programs that help people remain safely at home will not change. 

 

Why This is Happening 

  • Federal Medicaid funding for members with UIS is allowed only for emergency services delivered.
  • Managed care monthly payments (capitation) cannot be used because they are not directly for specific services. 
  • To maintain federal funding, California must move these members to DHCS Medi-Cal FFS, where providers are paid per service. 

To continue to serve Medi-Cal members transitioning to DHCS Medi-Cal FFS, providers must be enrolled in DHCS Medi-Cal FFS. To enroll, providers must complete a provider enrollment application with the DHCS Provider Enrollment Division (PED). Although members will no longer be assigned a Primary Care Provider under DHCS Medi-Cal FFS, providers may continue to see their patients if they are enrolled in DHCS Medi-Cal FFS.

 

If providers are already enrolled in Medi-Cal through PED via Provider Application and Validation for Enrollment (PAVE), providers may continue to offer services to IEHP members who have transitioned to DHCS Medi-Cal FFS and be eligible for reimbursement under DHCS Medi-Cal FFS.

 

If you are not currently enrolled through PAVE, you must submit an application and be approved to enroll by January 1, 2027, in order to receive reimbursement at FFS rates.

 

For more information on PAVE enrollment, please visit:

 

Please ensure that a hand-off with appropriate records is shared with colleagues, who will continue to care for these patients. A list of providers who are enrolled in DHCS Medi-Cal FFS can be found at:

Providers can register for DHCS Medi-Cal FFS trainings through the Medi-Cal Learning Portal. DHCS will continue to add new training opportunities as they are developed. IEHP encourages providers to check the DHCS Medi-Cal Learning Portal regularly for the latest updates and educational resources. The following trainings are currently planned by DHCS to support the transition to DHCS Medi-Cal FFS:

 

 

Medi-Cal Learning Portal

 

 

The Medi-Cal Learning Portal offers Medi-Cal providers and billers self-paced online training about billing basics, policies, procedures, new initiatives, and upcoming changes to the Medi-Cal program.

 

  • Users will be able to view the course catalog without logging in. To enroll in training events, users must log in.

 

  • First-time users must complete a one-time registration at:

 

  • For additional guidance and assistance with inquiries, providers may visit the DHCS Outreach & Education information:

 

The following DHCS Medi-Cal FFS Provider trainings are currently planned to support the transition: 

 

 

Date: Tuesday, December 1, 2026

 

Course Title: Introduction to Medi-Cal 101

 

Start Time: 1 p.m.

 

Duration: 1 hour 30 minutes

 

 

Date: Thursday, December 3, 2026

 

Course Title: Medi-Cal Provider Resources 102

 

Start Time: 10 a.m. 

 

Duration: 1 hour and 30 minutes

 

 

Date: Tuesday, December 8, 2026

 

Course Title: eTAR Basics 

 

Start Time: 1 p.m.

 

Duration: 1 hour 30 minutes

 

 

Date: Thursday, December 10, 2026

 

Course Title: Medi-Cal Claims Overview and Electronic Methods Live Webinar

 

Start Time: 10 a.m.

 

Duration: 1 hour 30 minutes

 

 

 

DHCS strongly encourages all providers to familiarize themselves with DHCS Medi-Cal FFS billing processes to prepare for billing DHCS Medi-Cal FFS after January 1, 2027. This includes:

 

Medi-Cal providers have access to billing and claims assistance through DHCS’ California Medicaid Management Information System (CA-MMIS) and its contracted Fiscal Intermediary (FI). CA-MMIS and FI staff can assist providers with questions about paper claim submissions, electronic claim submission, and Treatment Authorization Requests (TARs and electronic-TARs, or eTARs).

 

Medi-Cal providers can also contact the Telephone Service Center (TSC) by phone at 1-800-541-5555 (outside of California, 1-916-636-1980), Monday through Friday, except holidays, from 8:00 a.m. to 5:00 p.m.

 

For faster access to TSC resources, Medi-Cal providers can refer to the TSC Main Menu Prompt Options Guide: 

While Enhanced Care Management and Community Supports are not covered under DHCS Medi-Cal FFS, certain care management, care coordination, or case management services, as well as community health worker services, are available for coverage and reimbursement when billed in accordance with Medi-Cal Coverage Policy by eligible providers. Specifically, providers enrolled in DHCS Medi-Cal FFS may bill for eligible care management, case management, or care coordination activities using existing Medi-Cal 35 FFS billing codes to receive reimbursement for case management and care management functions.

 

DHCS plans to provide links and/or a resource document that includes the available codes for billing purposes under DHCS Medi-Cal FFS. The resource will include lists of potential codes, such as the ones listed below, with links to the appropriate provider manual that includes details on billing guidance.

 

 

CHWs

  • CPT codes: 98960, 98961, and 98962
  • HCPCS codes: G0019 and G0022.

 

Doula

  • CPT codes: 59409, 59612, 59620, and 59840
  • HCPCS codes: Z1032, Z1034, T1033, T1032, and Z1038.

 

Principle Care Management/Chronic Care Management

  • CPT codes: 99424, 99425, 99426,99427, 99490, 99491, 99437, 99439
  • HCPCS code: G0506

 

Case Management

  • CPT codes 99366, 99368, G9012 (HCBS/JI only)

 

General Behavioral Health Integration Care Management

  • CPT code: 99484 (JI only)

 

Transitional Care Management Services

  • CPT codes: 99439 (JI only)

 

Targeted CM

  • HCPCS code: T1017

 

Psychiatric Collaborative CM services

  • CPT code: 99492, 99493, 99494

 

CPSP

  • HCPCS codes: Z1032, Z6500, Z6200, Z6202, Z6204, Z6206, Z6208, S0197, Z6300, Z6302, Z6304, Z6306, Z6308, Z6400, Z6402, Z6404, Z6406, Z6408, Z6410, Z6412, and Z6414.

 

 

*Providers are encouraged to remind members to refill prescriptions before January 1, 2027, to avoid disruptions.

 

IEHP will provide additional information as DHCS finalizes transition updates, including:

 

  • Care management applicable billing codes in DHCS Medi-Cal FFS 
  • Member support pathways
  • Contact information for DHCS or MCP support channels

 

 

General DHCS Medi-Cal FFS Provider Resources

 

General information about enrolling as a provider in DHCS Medi-Cal FFS can be found on the "For Medi-Cal Providers" page:

 

 

Providers that are enrolled in DHCS Medi-Cal FFS may access various resources via the DHCS Provider Portal. For providers not yet enrolled in DHCS Medi-Cal FFS, there are publicly available resources on the Provider Portal References page:

 

DHCS Medi-Cal FFS Enrollment

 

MCPs, providers, and members can check to see if a provider is enrolled to bill DHCS Medi-Cal FFS at the following:  

 

 

DHCS Medi-Cal FFS provider type reference is available at the following:  

 

 

Requirements for enrollment by specific provider type:  

 

 

New providers enroll in DHCS Medi-Cal FFS by submitting a PAVE application. Tutorials on how to complete the application process are available here:  

 

 

Questions about provider enrollment can be submitted using the Provider Inquiry Form via the Provider Enrollment Division (PED) page: 

 

 

The latest provider notices related to UIS information can be accessed here:

Resources to Help with the Medi-Cal Renewal Process

The following resources for providers offer more information about the Medi-Cal Renewal process and tools to help your office proactively engage and encourage all IEHP members to renew their Medi-Cal coverage on time.

 

IEHP will continue to update you as policies related to Medi-Cal eligibility are implemented and share all tools developed to serve you and our members throughout this critical time. 

 

 

Medi-Cal Renewal Flyers for Provider Offices 

 

These flyers were designed to assist provider offices for ease of sharing with their patients, and they list helpful resources available to IEHP members, encouraging them to start renewing their Medi-Cal eligibility. The documents are available in the following threshold languages: 

Hospitals Outreach Toolkit: Keep Your Medi-Cal Coverage

 

As part of the Hospital Association of Southern California's (HASC) ongoing efforts to help hospitals navigate changes to Medi-Cal coverage, HASC has created the "Keep Your Coverage" bilingual toolkit. The toolkit includes ready-to-use, customizable communications materials in English and Spanish that hospitals can incorporate into their existing outreach channels, including social media, websites, newsletters, and other patient-facing communications.

Medi-Cal Renewal FAQs and Related Information for IEHP Members

 

The following links share information available on the "Medi-Cal Renewal" web pages created specifically for IEHP members to learn more about the topic. These pages also help answer the most "Frequently Asked Questions" asked by members about Medi-Cal eligibility and how to renew for the benefit.

Department of Health Care Services (DHCS) Resources

 

DHCS has developed a policy guide regarding the implementation plan of this benefit in relation to the enrollment changes under H.R.1. This resource covers an overview, key Medi-Cal eligibility changes under the new federal legislation, and DHCS's guiding principles in response to maintaining the benefit and program's integrity.

 

To access the latest Medi-Cal policy changes information, please visit:

IEHP Eligibility Renewal Support Team

IEHP’s Eligibility Renewal Support team is here to answer calls from members needing more one-on-one support during the Medical-Renewal process!

 

Please let your patients and our members know that additional application support is just a phone call away.

 

We support:

  • Application printouts
  • Assistance in connecting with the appropriate county department
  • Serving as a centralized eligibility hub for all eligibility-related issues (on hold, disenrolled, out of area, etc.)
  • Helping members update contact information (national change of address, undeliverable address, etc.)
  • Online submissions via BenefitsCal.com

 

IEHP Eligibility Renewal Support Team Hotline

  • Phone and Hours of Operation: 1-888-860-1296, Monday-Friday, 8 am - 5 pm (PST)
 
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