Effective January 1, 2027, certain Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from Medi-Cal managed care through the Alliance to Medi-Cal Fee-for-Service (FFS), as required by federal guidance.
Who is impacted?
This change applies only to Medi-Cal members identified by the California Department of Health Care Services (DHCS) as having an Unsatisfactory Immigration Status (UIS).
These members will continue to be eligible for Medi-Cal benefits. However, they will receive their covered medical services through Medi-Cal FFS instead of the Alliance.
What this means for providers
Beginning January 1, 2027:
- Impacted members will no longer be assigned to a primary care provider (PCP) under Medi-Cal FFS.
- Members may generally receive covered services from any provider who is enrolled in Medi-Cal FFS and accepting new patients.
- Providers who are not enrolled in Medi-Cal FFS will not be able to bill Medi-Cal FFS for services provided to impacted members after January 1, 2027.
- The Alliance will not be responsible for payment of services for impacted members for any services rendered after December 31, 2026.
Continue caring for your patients
- We encourage you to keep serving impacted members after January 1, 2027. If you would like to do so, you should verify that you are enrolled in Medi-Cal FFS through the Provider Application and Validation for Enrollment (PAVE) system.
- If you are already enrolled, no additional enrollment is required. You may continue providing services to these members and receive reimbursement under Medi-Cal FFS. You will need to bill Medi-Cal FFS in order to be paid for services to these members.
- If you are not enrolled, you must:
- Submit a Medi-Cal FFS provider enrollment application through the DHCS Provider Enrollment Division (PED).
- Obtain enrollment approval before January 1, 2027 to receive reimbursement for services provided to transitioning members.
Supporting patients during the transition
Members transitioning to Medi-Cal FFS will still have access to medically necessary Medi-Cal services. However, some services will be delivered differently after the transition.
- Enhanced Care Management (ECM) and Community Supports are only available through a Medi-Cal managed care plan. They will not be available to members transitioning to Medi-Cal FFS.
- Other Medi-Cal services, including Medi-Cal Rx pharmacy benefits and county behavioral health services, will still be available to Medi-Cal FFS members through their respective delivery systems.
How providers can help support a smooth transition
- Help patients understand how to access services through Medi-Cal FFS.
- Support continuity of medically necessary care whenever possible. If you are unable to continue caring for impacted members, please ensure a timely transfer of care by coordinating with the receiving provider and transferring the member’s medical records.
- Encourage impacted members to refill any needed prescriptions before January 1, 2027 to help avoid interruptions in medication therapy.
Resources
Please review the following resources to prepare for the Medi-Cal FFS transition:
- Enroll or update your Medi-Cal FFS enrollment
- Verify Medi-Cal FFS provider enrollment
- DHCS Medi-Cal Provider Portal, billing guidance and Provider Manual
- DHCS Treatment Authorization Requests (TAR) and billing requirements
The Alliance will share updates as DHCS releases additional guidance regarding the UIS transition. Providers are encouraged to monitor Alliance provider communications and the Alliance Provider Portal for updates and resources.
If you have questions, please contact your Provider Relations representative.
