Documentary record · published 27 October 2026 · source checked 26 October 2026 (Pacific)

DHCS publishes a Medi-Cal fee-for-service provider toolkit for the January 1, 2027 transition

Status: Readiness guidance published · Version 1.0 dated 14 October 2026 · transition takes effect 1 January 2027

• Source checked: 26 October 2026 (Pacific)
• Review status: physician and legal review required; not yet completed

What happened

The California Department of Health Care Services (DHCS) has published the Medi-Cal Fee-for-Service Provider Toolkit, Version 1.0, dated October 14, 2026. DHCS's Transition to Medi-Cal Fee-for-Service page links it as "key resources for providers during the transition." The toolkit says that starting January 1, 2027, "federal rules require that Medi-Cal members with Unsatisfactory Immigration Status (UIS) get their care through Medi-Cal Fee-for-Service (FFS) instead of a Medi-Cal managed care plan." It calls these members "impacted members" or "members with UIS." It describes the change as affecting "how care is delivered, not whether members remain eligible for Medi-Cal."

The 11-page document covers six areas:

• Enrollment. A provider who wants to keep seeing these members must be enrolled in Medi-Cal FFS. A provider's role under a managed care plan "does not carry forward." Providers already enrolled as FFS billing providers "don't need to do anything new." Providers who are not enrolled "must submit your application by January 1, 2027 to bill for these members." For most provider types, that application goes through the PAVE portal.
• Accepting patients. FFS has no primary-care assignment. Enrolling does not require a provider to accept every member who asks. DHCS says that updating "accepting new patients" capacity in the Provider Portal is "now required quarterly for all Provider Portal Administrators."
• Eligibility checks. Members will show their Benefits Identification Card (BIC) instead of a plan card. They will not automatically receive a new BIC. Providers verify eligibility through the Automated Eligibility Verification System (AEVS) or a point-of-sale device.
• Authorizations. In FFS, Treatment Authorization Requests (TARs) go to DHCS. A "special handling" option will apply when DHCS has a plan authorization on record for the same service. An eTAR is still required, but attachments supporting medical justification will not be needed if an approved plan authorization exists. Starting November 1, 2026, DHCS will accept TARs for impacted members for dates of service on or after January 1, 2027. For authorizations a plan received before January 1 covering later services, the plan may keep processing them or refer the provider to the DHCS TAR process.
• Transportation. Non-medical and non-emergency medical transportation continue in FFS. Transportation providers must also be enrolled in FFS to serve impacted members after January 1.
• Care management and billing. The toolkit lists billing codes for services that remain available, including community health worker, psychiatric collaborative care, perinatal (CPSP), doula, dyadic and asthma preventive services. Enhanced Care Management, Community Supports, California Integrated Care Management, Complex Care Management and Transitional Care Services will not be available in FFS.

What this does and does not mean

This is readiness guidance. It does not show that any provider is enrolled in Medi-Cal FFS, that an application filed now will be processed by January 1, or that any individual service is authorized. Each of those needs its own confirmation through PAVE, an eligibility check or a TAR decision. DHCS itself states that its billing-code table "does not guarantee" FFS payment. The "Version 1.0" label means the document may be revised. Continuity-of-care expectations are set out in a separate DHCS Policy Guide, which this record does not summarize.

Who it affects

The toolkit is written for physicians, clinics, hospitals and transportation providers who now see members with UIS through managed care plans. It also affects providers of Enhanced Care Management and Community Supports, whose services end for these members in FFS. The people directly affected are the members themselves. The site's patient page explains the change in plain language.

What to watch

• 1 November 2026: DHCS starts accepting TARs for dates of service on or after 1 January 2027.
• 1 January 2027: The transition takes effect. It is also the toolkit's stated date for submitting an FFS enrollment application.
• Later: Any Version 1.1 or later toolkit, updates to the Policy Guide, and further DHCS guidance on billing codes for care management in FFS.

Sources

1. California Department of Health Care Services, Medi-Cal Fee-for-Service Provider Toolkit, Version 1.0, 14 October 2026. https://www.dhcs.ca.gov/wp-content/uploads/2026/10/DHCS-FFS-Provider-Toolkit-68872c.pdf
2. California Department of Health Care Services, "Transition to Medi-Cal Fee-for-Service" (providers page; links the Provider Toolkit and the Policy Guide). https://www.dhcs.ca.gov/providers-partners/medi-cal-fee-for-service-transition/