DHCS prepares a January 1 transition to fee-for-service for specified immigration-status coverage
Oct 4, 2026 edition · GC-2026-0120 · Published 2026-10-04 · Version 2 · Final
DHCS’s September 29 transition notice highlights fee-for-service enrollment and billing readiness for affected UIS members before January 1.
What happened
DHCS’s September 29 provider notice adds a resource page for the January 1, 2027 transition of Medi-Cal members with unsatisfactory immigration status from managed care to fee-for-service. It emphasizes that this changes how care is delivered, not whether members remain eligible, and says members keep full-scope coverage if they renew on time. The September stakeholder news separately described the January transition, member and provider resources and a September 30 readiness webinar. As of October 4, the webinar date has passed; the transition itself remains ahead.
The provider notice warns that organizations billing only through managed care, without Medi-Cal fee-for-service enrollment, cannot continue caring for affected members after December 31, 2026. It directs providers to update PAVE enrollment, confirm screening and revalidation, review fee-for-service billing including Treatment Authorization Requests, and update capacity information for new fee-for-service members. Enrollment, authorization and receiving-provider capacity therefore need coordinated review, while each member’s eligibility and renewal remain separately verified. A provider’s managed care contract by itself does not establish the enrollment needed for the new delivery arrangement.
Scope and timing
- Authority status
- Final
- Applicability
- Directly applicable
- Audience
- Health systems, Provider networks
- Jurisdiction
- California
- Affected functions
- Managed Care, Patient Access, Revenue Cycle, Case Management, Compliance, IT
- Responsible owner
- Managed Care
- Recorded date
- 2027-01-01
- Date type
- implementation
Why it matters
Continuity can fail if member transitions are planned without validating fee-for-service enrollment, billing and provider capacity.
Recommended action
Verify current PAVE fee-for-service enrollment, screening and revalidation, review TAR and billing workflows, and reconcile member-specific referrals and capacity before January 1.
Implementation playbook
- Identify affected members and services; confirm eligibility and continuity requirements individually. Managed Care · Due 2026-10-18
- Confirm PAVE fee-for-service enrollment, screening and revalidation for every participating location and clinician. Provider Enrollment · Due 2026-11-01
- Reconcile authorizations, referral pathways and fee-for-service capacity before the transition. Clinical Operations · Due 2026-12-31
Sources
- DHCS Stakeholder News, September 14, 2026Official · California Department of Health Care Services · 2026-09-15 · Source review 2026-09-20
- New Medi-Cal Providers Web Page: Medi-Cal Managed Care to Fee-for-Service TransitionOfficial · DHCS · 2026-09-29 · Source review 2026-10-05
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
Read the entire Medicare & Medicaid report →