Starting January 1, 2027, federal rules require that some Medi-Cal members get their care through Medi-Cal Fee-for-Service instead of a Medi-Cal health plan.

This change affects how members get care, not whether they stay covered. Members who renew Medi-Cal on time will keep full-scope Medi-Cal.

Impacted members can see any doctor, clinic, or hospital that accepts Medi-Cal Fee-for-Service. Members pick their own providers, and Medi-Cal pays providers directly for each visit or service.

Fee-for-Service does not mean members pay. Medi-Cal still covers the cost of care.

Upcoming Webinar

September 30, 10 -11 a.m.: Join DHCS for an overview of the January 1, 2027 transition, online tools, provider readiness steps, and materials available to support members. Registration is required.

Who This Applies To

This change applies to Medi-Cal members with Unsatisfactory Immigration Status, including:

• Undocumented members living in the U.S. without legal immigration status.
• Green Card holders who are still in the five-year waiting period before they can get federally funded Medicaid.
• Members who are PRUCOL (Permanently Residing Under Color of Law) meaning they are allowed to live in the U.S. with permission from immigration officials, even though they do not have legal status.

Check the Immigration Status Categories chart to see if this change applies to you.

Important Note: This change applies to all members with Unsatisfactory Immigration Status, including:

• Babies and children
• Pregnant members (including one year after pregnancy)
• Adults
• Members with disabilities

What’s Changing

• Members will not be in a Medi-Cal health plan anymore.
• They can go to any doctor, clinic, or hospital that takes Medi-Cal Fee-for-Service.
• Members pick their own doctors and make their own appointments.
• Enhanced Care Management and Community Supports are not offered in Medi-Cal Fee-for-Service. These services give extra help to members with complex needs, and help with things like finding a place to live or making changes to a home that support health.
• Members can still get important services in Fee-for-Service, including:
  • Chronic care management for long-term conditions like asthma or diabetes.
  • Doulas who help before, during, and after childbirth.
  • Community Health Worker services to help with health education, finding resources, and renewing Medi-Cal.

What’s Not Changing

• Members will not pay for care. Medi-Cal will still pay for care.
• Members will keep full-scope Medi-Cal if they renew on time.
• Medi-Cal benefits stay the same, including:
  • Doctor visits
  • Medicines
  • Dental care
  • Hospital care
  • Lab tests
• Members will still get mental health and substance use services.
  • Non-specialty mental health services (available in Medi-Cal Fee-for-Service) support mild-to-moderate mental health needs such as anxiety, depression, and stress.
  • Specialty mental health services (provided through County Behavioral Health Plans) support more serious mental health conditions that significantly affect daily life.
• Members in the Program of All-Inclusive Care for the Elderly will stay in PACE.

What Members Need to Do

• Ask their doctor or clinic: “Do you take Medi-Cal Fee-for-Service?”
  • If yes, they can keep going there.
  • If no, they will need to find a new doctor who takes Medi-Cal Fee-for-Service.
• If members need help finding a doctor, they can use the Find Doctors and Services locator or call the Medi-Cal Help Line at 1-800-541-5555.
• Watch their mail. Medi-Cal will send letters about this change.
• Keep contact information up to date. Make sure the member’s county or BenefitsCal have their correct address, phone number, and email.
• Use their Medi-Cal Benefits Identification Card (BIC).
  • Health plan cards will not work in Fee-for-Service.
  • Bring the BIC to every appointment starting January 1, 2027.
  • If the BIC is lost or damaged, get a new one from the county Medi-Cal office or BenefitsCal.com.
• If a member uses equipment like a wheelchair, walker, or oxygen, they should call the Medi-Cal Help Line at 1-800-541-5555. Help Line staff will help make sure the equipment stays covered and assist with finding a provider if needed.
• Renew Medi-Cal on time to keep full-scope coverage.

Resources

Members

• Immigration Status Categories Chart: Shows the groups included in this change.
• Find Doctors and Services: Find who takes Medi-Cal Fee-for-Service.
• Frequently Asked Questions: Answers to questions about the change.
• Member Notices (coming soon): Letters from Medi-Cal explaining what is changing and what to do next.
• What Members Need to Know: Updates about changes to Medi-Cal.
• Help Center: How members can use and keep their benefits.
• Immigration Help: Support for immigrants, including legal help and support during emergencies.
• Complaints and appeals: How to file a complaint or an appeal if a member has trouble getting care or services.
• County Medi-Cal Offices: Get help with Medi-Cal, health coverage, and other benefits.
• Medi-Cal Help Line: 1-800-541-5555.

Providers

Providers can visit the Medi-Cal Provider Portal, which will be updated regularly to include:

• Medi-Cal Fee-For-Service provider enrollment (using Provider Application and Validation for Enrollment system)
• Claims and billing guidance
• Treatment Authorization Request requirements
• Provider bulletins
• Updates and training about this transition