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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 Unsatisfactory Immigration Status (UIS) members 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 - Unsatisfactory Immigration Status (UIS)

Effective January 1, 2026, IEHP members with UIS already enrolled in Medi-Cal will continue to receive full-scope Medi-Cal coverage. However, members 19 years of age or older may risk losing coverage if they allow their eligibility to lapse. It will be important for UIS members who are already enrolled in the Medi-Cal program to renew their coverage in a timely manner. 

 

The Department of Health Care Services (DHCS) has developed a more in-depth informational chart detailing the various immigration categories and the corresponding eligibility coverage available, dependent upon the immigration status of UIS members.

 

To view the chart mentioned and related information regarding this topic, please visit the following:

 

In addition, effective January 1, 2027, IEHP members with UIS will transition to the Medi-Cal Fee-For-Service (FFS) delivery system. To support a smooth transition for providers and your members, DHCS is providing the following important information regarding provider enrollment, billing, and ongoing care responsibilities.

To continue to serve Medi-Cal members transitioning to Medi-Cal FFS, providers must be enrolled in 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 Medi-Cal FFS, providers may continue to see their patients if they are enrolled in 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 Medi-Cal FFS and be eligible for reimbursement under 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 Medi-Cal FFS can be found at:

 

DHCS strongly encourages all providers to familiarize themselves with Medi-Cal FFS billing processes to prepare for billing 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 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 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 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 Medi-Cal FFS 
  • Member support pathways
  • Contact information for DHCS or MCP support channels

 

 

General Medi-Cal FFS Provider Resources

 

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

 

 

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

 

Medi-Cal FFS Enrollment

 

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

 

 

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

 

 

Requirements for enrollment by specific provider type:  

 

 

New providers enroll in 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: 

 

 

Medi-Cal FFS Provider Trainings

 

DHCS will update this section as trainings are developed and scheduled to help support the UIS Transition. 

 

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: 

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)
 
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.