Medi-Cal changes are coming — help members stay covered

Starting in 2026, some Medi-Cal members may see updates to their health coverage. Most members will keep their current benefits and care, but others may experience changes to their coverage.

The Alliance is working to make this transition as smooth as possible. Our goal is to ensure that every eligible member stays covered and continues receiving the care they need.

To support this effort, the Alliance has launched a multi-channel outreach campaign. This includes flyers, website resources, community outreach, media campaigns and text reminders to help members stay informed and maintain their coverage.

 How you can help 

We’re asking our provider network and community partners to share information about these upcoming changes. You can help raise awareness by encouraging individuals to:

• Enroll before the end of the year if they think they may be eligible for Medi-Cal.
• Update their contact information with their county to avoid losing coverage.
• Review their mail and respond quickly to any renewal letters from Medi-Cal.
• Reach out to their county social services office if they have questions about their Medi-Cal eligibility.

Keeping coverage active means uninterrupted access to doctors, prescriptions and preventive care.

Resources for providers and members 

The Alliance created a Medi-Cal Redetermination Toolkit for providers that includes flyers in three languages and videos in English and Spanish that are available for download. Flyers and videos can be distributed and streamed in office lobbies and waiting areas. We’re also encouraging providers to direct members to Medi-Cal changes webpage to access more information.

We will be updating these flyers and videos in coming weeks to include the most current information and will provide links to these materials in the January edition of the Provider Digest.  

New Colorectal Cancer Screening report now available

Colorectal cancer is preventable when detected early. Providers now have access to a new report for Colorectal Cancer Screening designed to help practices identify and reach patients who are due for screening. This report can strengthen your preventative care efforts, existing workflows and help close care gaps. Improving performance on this measure may also positively influence your overall Care-Base Incentive (CBI) outcomes.

The report also includes patient-level details like:

• Name.
• Age.
• Contact information.
• Screening dates.

You can access the report in the Provider Portal under Quality Reports.

The Alliance will also be texting members who are overdue for a colorectal screening in March and September.  

For more information about the Colorectal Cancer Screening measure, see the Colorectal Cancer Screening tip sheet. For questions or help integrating this report into your workflows, please contact the CBI Team at [email protected].

Review neuropsychology testing codes

Neuropsychology testing services are a covered benefit when using a standardized instrument. Codes 96112 and 96113 are covered with the following billing limits:

• 96112: Developmental test administration, first hour.
  • Can be used once within a 12-month period.
• 96113: Developmental test administration, each additional 30 minutes.
  • Must be billed with 96112.
  • Can be used up to 10 per day (one unit is equal to 30 minutes).

Providers can administer neuropsychology tests across multiple visits. When providers submit claims, best practices include:

• Submitting all associated services together on one claim.
• The claim should be submitted on the final date of service, after all testing has been completed.
• Each line item may indicate its applicable date of service and number of units based on time spent.
• Submitting testing performed on separate days as individual claims may result in claim denials.
• Total combined time must not exceed 6 hours.

Other Developmental Screenings

For guidance on other developmental screenings (like reference codes and frequencies in the Medi-Cal preventive service manual section.

Developmental Surveillance

The American Academy of Pediatrics recommends routine developmental at every well-care exam. This service is not separately reimbursable when billing the appropriate well-care evaluation and management code.

Resource Update

Current Procedural Terminology codes 96112 and 96113 will be included in the Pediatric Screening Tool as part of the upcoming annual resource review in January. Please reach out to [email protected] with additional questions.

Miss our November immunization webinar? View our recording online!

If you missed our immunization webinar in November, you can now access the full recording and related resources online!

Key topics covered during the webinar include:

• Misinformation and disinformation on vaccination.
• Tips on how to educate members on the importance of vaccination.
• Reframing the conversation with science-based content.
• Best practices.
• Barriers to immunization access.

Additional trainings and webinars can be accessed on our website at Provider Webinars and Training – Central California Alliance for Health.