Home Medi-Cal Updates Fee-for-Service Transition Notice of Additional Information

Notice of Additional Information

Fee-for-Service Transition

Medi-Cal

Important information about changes to how you get Medi-Cal care

Your Medi-Cal coverage is changing. A new federal rule requires California to change how some members who do not meet certain federal immigration requirements get Medi-Cal services. You are NOT losing Medi-Cal. You will still have Medi-Cal. But the way you get services will change.

Starting January 1, 2027, you will move from a Medi-Cal health plan to Medi-Cal Fee-for-Service. After this change, some services may work differently, and some services may not be available.

You will get care through Medi-Cal Fee-for-Service. Fee-for-Service is a way Medi-Cal pays doctors and other care providers. The State of California will manage and pay providers for your Medi-Cal benefits starting January 1, 2027. You will get your Medi-Cal services through providers such as a doctor or clinic who accept Medi-Cal Fee-for-Service.

If you are in a Medi-Cal dental plan, you will stay in that Medi-Cal dental plan.

This notice explains what is changing and what you may need to do.

Why is this changing?

For members who do not meet certain federal immigration requirements for full-scope Medicaid, the federal government only helps pay for emergency services.

In managed care, the State pays Medi-Cal health plans a monthly amount, even if a member does not use any services that month. Because these payments are not for a specific emergency service, the federal government will not help pay for them.

General Questions

1. What are the differences between Medi-Cal Fee-for-Service and Medi-Cal Managed Care?

Medi-Cal Fee-for-Service works differently than a Medi-Cal health plan. If you have Medi-Cal Fee-for-Service, you can go to any Medi-Cal provider, such as a doctor, hospital, or clinic, who takes Medi-Cal Fee-for-Service. You are not limited to a health plan network.

Certain services from your current Medi-Cal health plan will no longer be available in Medi-Cal Fee-for-Service. Medi-Cal Fee-for-Service does not offer Enhanced Care

Management (ECM) or Community Supports. If you have a Lead Care Manager through ECM that provides you with extra support or if you get medically tailored meals, housing-related supports, or similar services, these services will no longer be available.

Other services may still be available to help you. Contact your current Medi-Cal health plan or your ECM or Community Supports provider to prepare for this change.

2. How do I find a provider and get health care in Medi-Cal Fee-for-Service?

  • You can go to any provider, such as a doctor, hospital, or clinic, who accepts Medi-Cal Fee-for-Service.
  • If you already have a doctor or clinic, call their office, ask if they accept Medi-Cal Fee-for-Service. If they do, you can keep going to them.
  • When you call a provider, ask if they are taking new patients with “Medi-Cal Fee-for-Service.”
  • To find a Medi-Cal Fee-for-Service provider, you can:

3. What if I already have appointments for January 1, 2027 or after?

Ask your current provider if they accept Medi-Cal Fee-for-Service. If they do, you can keep the appointment. If they do not accept Medi-Cal Fee-for-Service, you will need to cancel the appointments and find a new provider who accepts Medi-Cal Fee-for-Service. For help finding a new provider, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555.

4. Can I keep appointments I have with a Medi-Cal specialist?

Ask your current Medi-Cal specialist if they accept Medi-Cal Fee-for-Service. If they do, you can keep your appointments. If they do not accept Medi-Cal Fee-for-Service, you will need to cancel the appointments and find a new Medi-Cal specialist who accepts Medi-Cal Fee-for-Service. For help finding a new Medi-Cal specialist, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555.

5. What if I think this change should not apply to me?

If you believe this new change should not apply to you because you believe your immigration status or another qualifying category allows you to stay enrolled in your current Medi-Cal health plan, contact your local county Medi-Cal office. The county may ask you to provide documentation to review your eligibility and determine whether you can stay enrolled in your Medi-Cal health plan.

Important to note: this eligibility review is about how you get your Medi-Cal services. You are not losing your Medi-Cal coverage. This notice is to tell you about new changes to how you get your benefits only.

Find your local county Medi-Cal office.

6. Will my prescriptions and pharmacies change?

Most prescription medicines will stay the same. Your Medi-Cal Rx pharmacy benefit will not change. When you start going to a new Medi-Cal Fee-for-Service doctor, make sure they know what prescriptions you get now. Tell them if you need a refill. If you have Medicare, your Prescription Drug Plan (Part D) coverage will still work with Medi-Cal Rx.

Some pharmacy benefits that are billed as a medical claim will change. Examples of these types of benefits are medical supplies such as tracheostomy supplies, wound care, catheters, and incontinence supplies. These benefits should be billed to Medi-Cal Fee-for-Service and not to your prior Medi-Cal health plan.

For help finding a Medi-Cal Fee-for-Service provider for your medical supplies billed on a medical claim, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555. Tell them you need a Medi-Cal Fee-for-Service provider for your medical supplies billed as a medical benefit. Tell them the type of supplies you have.

7. If I have durable medical equipment (DME), can I keep it when I am in Medi-Cal Fee-for-Service?

DME means medical items you use at home to help you with your health every day. DME includes wheelchairs, walkers, oxygen machines, or other equipment that helps you move, breathe, or stay safe. If you own the DME, you can keep it when you are in Medi-Cal Fee-for-Service. If you rent DME, you will need to make sure you can rent that DME beyond January 1, 2027. You will need approval from a Medi-Cal Fee-for-Service provider to have the rented item.

For help finding a Medi-Cal Fee-for-Service provider for your DME, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555. Tell them you need a Medi-Cal Fee-for-Service provider for your DME. Tell them the type of DME you have.

8. If Medi-Cal pays for my transportation, can I keep my scheduled rides?

If you have transportation needs through Non-Emergency Medical Transportation (NEMT) or Non-Medical Transportation (NMT), you may still keep getting rides. But you will need to complete a form to get those rides.

For NEMT, you will also need to go to your Medi-Cal Fee-for-Service provider for a new prescription to keep the service once you are in Medi-Cal Fee-for-Service.

For questions about transportation services, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555 once you join Medi-Cal Fee-for-Service.

To learn more, go to the Frequently Asked Questions (FAQ) for Medi-Cal Transportation Services webpage.

Or call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555.

9. When I join Medi-Cal Fee-for-Service, will I need a new authorization for a Medi-Cal service I get now?

Yes. You will need a new authorization for Medi-Cal Fee-for-Service. You may need to go to your new provider for a new treatment plan to keep the service. They will submit a new authorization to Medi-Cal Fee-for-Service. For questions about your authorization, call your new provider.

10. When I join Medi-Cal Fee-for-Service, can I keep my primary care provider (PCP) or clinic?

Ask your PCP or clinic if they accept Medi-Cal Fee-for-Service. If they do, you can keep them. If they do not accept Medi-Cal Fee-for-Service, you will need to find a new provider. For help finding a new provider:

11. If I get behavioral health treatment, will my county provider change?

If you get any behavioral health services through Specialty Mental Health Services, Drug Medi-Cal (DMC), or Drug Medi-Cal Organized Delivery System (DMC-ODS) programs, those services and benefits will not change.

12. When I join Medi-Cal Fee-for-Service, will I still get the Enhanced Care Management and Community Supports services I currently get from my Medi-Cal health plan?

No. Some services available through Medi-Cal health plans will no longer be available when you move to Medi-Cal Fee-for-Service. This includes

  • Enhanced Care Management (ECM): Extra help coordinating your medical care, such as appointments, medications, or other health needs through Medi-Cal.
  • Community Supports: Extra services that may help with housing transition and navigation services, access to medically tailored meals and medically supportive food, and environmental modifications for asthma remediation.

Only Medi-Cal health plans provide ECM and Community Supports. These services will stop after you move to Medi-Cal Fee-for-Service because these services are only available through Medi-Cal health plans. If you were getting ECM, you may qualify for other Medi-Cal care management or coordination of benefits.

Your regular doctor or clinic (also called a Primary Care Provider or PCP) would provide care coordination services. These include support finding a specialist when referred to one or making sure you have a doctor’s appointment after you were recently discharged from the hospital. If you need support finding other health care services, ask your PCP. Or call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555.

13. Will my child keep the same benefits they have in the Whole Child Model California Children’s Services (WCM CCS) Program?

Yes. Your child will have the same WCM CCS benefits they had in the WCM CCS Program. Your child will keep getting services that are medically necessary and prescribed by your child’s provider. Please contact your County Children’s Services (CCS) Program Office for questions related to CCS program services or if you need help in understanding your child’s coverage or care. View the directory of County CCS Program Offices.

14. What if I get a medical bill?

If you get a bill from a provider or from your current Medi-Cal health plan, call your current Medi-Cal health plan. You can call the number on the back of your Medi-Cal health plan card. They will tell you if you need to pay the bill. If you got care without your Medi-Cal health plan’s authorization for out-of-network doctors, you may have to pay the bill.

After talking to the Medi-Cal health plan, if you still think the bill is wrong, you can file a grievance and/or appeal with the Medi-Cal health plan. The Medi-Cal health plan can tell you how to file a grievance or appeal.


If you get a bill for a service you got with Medi-Cal Fee-for-Service, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555. Ask if you need to pay the bill.

If you still think the bill is wrong after you call the Medi-Cal Helpline, you can contact DHCS to file a complaint. Call (916) 345-8980. Or email: Medi-Cal.Benefits@dhcs.ca.gov.

To learn more, go to File a Complaint.

For Medi-Cal Members who also have Medicare or a Medi-Medi plan

15. Will I still have Medicare?

Starting July 4, 2025, Medicare eligibility is restricted to U.S. citizens, lawful permanent residents, certain Cuban and Haitian entrants, and persons who live in the U.S. under the Compacts of Free Association. For questions about your Medicare status, please call (800) MEDICARE (800-633-4227). Help from Medicare is available 24 hours a day, seven days a week, except for some federal holidays.

16. What if I am enrolled in a Medi-Medi plan?

A Medi-Medi plan is a type of Medicare plan for people who have both Medicare and full-scope Medi-Cal. It combines Medicare and Medi-Cal services into one plan. Since you no longer qualify to be in a Medi-Cal health plan, you cannot be in a Medi-Medi plan. If you are in a Medi-Medi plan, you will be moved to Medi-Cal Fee-for-Service as of January 1, 2027.

If you still qualify for Medicare, you can get your benefits through Original Medicare. Or you can join another Medicare plan. You can learn more about your Medicare choices at Medicare.gov. Or call (800) MEDICARE (800-633-4227).

Or call the Health Insurance Counseling and Advocacy Program (HICAP) at (800) 434-0222.

Questions?

17. Where can I learn more or get help?

  • If you have general Medi-Cal questions, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555. The call is free. They will help you learn more about what services you can get through Medi-Cal.
  • If you have questions about dental care, call the Medi-Cal Dental Telephone Service Center Monday – Friday, 8 a.m. to 5 p.m., at (800) 322-6384. The call is free. Or go to www.smilecalifornia.org.
  • If you need help using your Medi-Cal benefits or understanding your rights, call the Medi-Cal Ombudsman Office Monday – Friday, 8 a.m. to 5 p.m., at (888) 452-8609 (TTY: 711 for California State Relay). The call is free. Or email MMCDOmbudsmanOffice@dhcs.ca.gov.
  • If you have both Medicare and Medi-Cal, call the Medicare and Medi-Cal Ombudsperson Program (MMOP) at (855) 501-3077. The call is free. The MMOP can help dual eligible members with questions about coverage, enrollment, and getting care.
  • Learn more about Medi-Cal Medi-Medi plans. Or go to Medi-Medi plans.
  • If you want a printed copy of this Notice of Additional Information (NOAI) mailed to you or in another format like large print, audio, or Braille, call Medi-Cal Health Care Options (HCO) Monday – Friday, 8 a.m. to 6 p.m., at (800) 430-4263 (TTY: (800) 430-7077). The call is free. Or go to Medi-Cal HCO. HCO is a service that helps members learn about Medi-Cal health and dental plans.
  • Learn more about Medi-Cal program changes.
  • For questions about changes to the scope of Medi-Cal coverage based on immigration status, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555. The call is free.
  • Find your local county Medi-Cal office.
  • For questions about your Medi-Cal health plan, contact your Medi-Cal health plan. To find your Medi-Cal health plan, go to the Medi-Cal health plan directory.