Medi-Cal Proposition 35 Primary and Specialty Care Supplemental Payment
Proposition 35
California voters approved Proposition 35 at the November 5, 2024 General Election making permanent the MCO Tax, subject to continued federal approval, and dedicating the resulting revenues to specified Medi-Cal program purposes beginning in 2025.
Proposition 35 requires the California Department of Health Care Services (DHCS) to consult with a stakeholder advisory committee prior to proposing or implementing any new provider payments or changes to existing provider payments supported by the MCO Tax.
Primary and Specialty Care Supplemental Payment
DHCS has developed Primary and Specialty Care supplemental payment increases effective for dates of service on or after July 1, 2026, to December 31, 2026, pursuant to Proposition 35, the Protect Access to Health Care Act. The supplemental payment increases are pending federal approval of State Plan Amendment (SPA) 26-0029. If approved, these supplemental payment increases will apply to eligible providers in the Medi-Cal Fee-For-Service delivery system and eligible network providers contracted with Medi-Cal managed care plans.
Eligible Providers
Primary or Specialty Care Service Codes identified as evaluation & management for office visits, vaccine administration, and other procedure codes commonly utilized by primary care, specialists, and emergency department physicians and billed using Health Insurance Claim Form (CMS-1500) are eligible for the supplemental payment.
For split billable codes with a technical/professional component, only the professional component (modifier 26) is eligible for supplemental payment.
The following provider types are eligible for supplemental payment when rendering qualifying services billed on CMS-1500:
- Physicians
- Physician Assistants
- Nurse Practitioners
- Podiatrists
- Certified Nurse Midwives
- Licensed Midwives
- Doula Providers
- Psychologist
- Licensed Professional Clinical Counselors
- Marriage and Family Therapists
- Pupil Personnel Services (PPS) credentialed practitioners:
- Credentialed School Conselors
- Credentialed School Psychologists
- Credentialed School Social Workers
Procedure codes identified as Obstetric and Non‑Specialty Outpatient Mental Health Services are eligible for supplemental payments when billed or rendered by all otherwise eligible provider.
Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), other providers that are reimbursed through an all-inclusive rate or a cost-based system, and Providers subject to the Clinic Upper Payment Limit pursuant to State Medicaid Director Letter 13-003 are not eligible for these supplemental payments.
Primary and Specialty Code List Development
In March 2026, DHCS published a preliminary Primary and Specialty Care code list for stakeholder feedback and review. The comment period closed on April 10, 2026.
DHCS reviewed stakeholder feedback and presented a revised Primary and Specialty Care code list to the Protect Access to Health Care Act Stakeholder Advisory Committee (PAHCA-SAC) on May 28, 2026.
In May 2026, DHCS published an updated Primary and Specialty Care code list for additional stakeholder feedback and review. The comment period closed on June 12, 2026.
DHCS has considered the feedback received from PAHCA-SAC and other stakeholders and has updated the procedure code list and supplemental payment amounts.
Redline code list with Reason for Exclusion: Redlined code list
The public notice was published on June 30, 2026, and can be accessed through the link below.
Rate Information
Please submit any questions to: P35CodeList Feedback@DHCS.ca.gov