Date: Tuesday, September 22, 2026​​ 

Time: 2 p.m. – 4 p.m.​​ 

DHCS Staff Presenters: Michelle Baass, Director; Tyler Sadwith, State Medicaid Director; Chris Esguerra, Deputy Director, Chief Quality and Medical Officer, Quality and Population Health Management​​ 

SAC Members in Attendance: Adam Dorsey, Al Senella, Anna Leach-Proffer, Beth Malinowski, Carlos Lerner, Chris Perrone, Christine Smith, Danielle Bradley, Janice Rocco, Jennifer Ruiz, Katie Rodriguez, Kim Lewis, Kiran Savage-Sangwan, Laura Sheckler, Lily Dorn, Linda Nguy, Marina Owen, Michelle Cabrera, Ryan Witz​​ 

BH-SAC Members in Attendance: Adrienne Shilton, Al Senella, Danielle Bradley, Dannie Ceseña, Jei Africa, , Kim Lewis, Kiran Savage-Sangwan, Kirsten Barlow, Leticia Galyean, Linnea Koopmans, Michelle Cabrera, Robert Harris, Rose Veniegas, Sara Gavin, Veronica Kelley​​ 

Additional Information: Please refer to the PowerPoint presentation used during the meeting for additional context and details.​​ 

Panimula at Buod ng Nilalaman​​ 

• During the August 19, 2026, SAC/BH‑SAC meeting, members said the unsatisfactory immigration status (UIS) to Medi‑Cal fee‑for‑service (FFS) transition could disrupt access to and continuity of care and create confusion due to unclear communication and unfamiliar processes. Also, members emphasized that transitioning nearly two million people in a single day represents a major system change with significant risks for providers, plans, and vulnerable populations. These concerns prompted stakeholders to request this additional ad hoc stakeholder meeting for further discussion to clarify issues and provide updates on DHCS’ transition plans.​​ 
• Attendees were reminded that public comments would be limited to written statements only for this session to give all stakeholders an opportunity to share their perspectives within the meeting’s time constraints.​​ 

Topic Discussed​​ 

Transition of Medi-Cal Members with UIS to FFS​​ 

Chris Esguerra, Pangalawang Direktor, Punong Opisyal ng Kalidad at Medikal, Pamamahala ng Kalidad at Kalusugan ng Populasyon​​ 

DHCS outlined California’s transition of approximately 2 million Medi-Cal members with UIS from managed care to FFS, effective January 1, 2027. Driven by new federal guidance restricting Medicaid funding to emergency services for UIS, the shift ensures continued coverage, but changes how care is accessed. Affected populations include undocumented immigrants, certain lawful residents, and others, while U.S. citizens and some groups remain unaffected. Members will retain full-scope benefits, though some managed care-only services will be lost. DHCS noted it is coordinating extensive outreach, provider readiness, and care management to minimize disruption, with targeted support for high-risk individuals and counties. Resources, policy guides, and communication strategies are in place to help members, providers, and plans navigate the transition smoothly, emphasizing continuity, compliance, and stakeholder engagement.​​ 

Talakayan​​ 

• A member asked DHCS to explain the status and timeline of the care management contract. DHCS clarified that contracting and program design were being developed in parallel to ensure seamless coordination between the DHCS call center and the care management vendor. They emphasized that workflows, referral pathways, analytics expectations, and meaningful performance outcomes, such as verifying that members were connected to at least two appointments, were being built into the design. DHCS noted that most design finalization was expected in November and December, with the goal of having the care management functions stood up by late December and fully operational by January.​​ 
• A member asked how upcoming eligibility redeterminations for the UIS population, particularly the July 1, 2027, shift to restricted‑scope Medi-Cal for certain Qualified Non‑Citizens (QNC) affected by H.R.1, interact with the current transition, noting that messaging may become confusing and that some members could face a coverage cliff if they do not renew on time. They also raised concerns that county behavioral health agencies currently lack visibility into which clients are UIS and may need advance guidance to support individuals who will retain behavioral health services, but lose managed care physical health benefits. DHCS clarified that full-scope coverage for the affected QNC group is maintained until July 1, 2027, under the state budget, and this information is already included in all member‑facing materials. DHCS added that a Frequently Asked Questions (FAQ) and one‑page resource for county behavioral health plans is being developed to outline what is not changing, provide needed codes and information, and help counties understand how to access resources and referrals once they learn a client is transitioning to FFS UIS care.​​ 
• A member asked how DHCS planned to ensure that the $8 million allocated for person‑to‑person navigation services would reach individuals who are not clinic patients, and also expressed concern that consumers might mistakenly continue seeing non‑FFS‑enrolled providers and receive inappropriate bills. DHCS responded that while part of the funding goes to clinics, navigators are expected to conduct outreach throughout the broader community, supported by ethnic and community media to extend reach beyond clinic settings. DHCS also acknowledged the billing concern and emphasized that member messaging will reinforce that Medi‑Cal members should not be billed, providing reminders on how to file a complaint if it occurs, and ensuring these protections are incorporated into future communications.​​ 
• A member asked DHCS to confirm that Children’s Health Insurance Program Reauthorization Act (CHIPRA) protections apply to all children under age 21, not only pregnant or postpartum individuals, and whether any children and youth could transition into more favorable eligibility categories to retain federal funding and stay in managed care. They also sought clarification on whether the managed care exclusion applies to dental services, requested more detail on provider survey findings (including which provider types are enrolled, but not billing and whether enrollment efforts are increasing active participation), and asked for additional information about risk‑stratification categories, weekly updates, and if dually eligible members were included in the analysis. Finally, the member urged DHCS to send notices earlier than December 1, 2026, so families have more time to secure continuity of care. DHCS responded that CHIPRA applies to children and pregnant individuals under Medicaid and CHIPRA 214 populations; the federal guidance does not affect dental managed care; provider enrollment activity is being monitored as an early indicator of transition readiness; risk‑stratification definitions and updates would be shared with managed care plans (MCP); dually eligible members are included in a separate sub‑analysis due to their heightened vulnerability; and while official notices are scheduled for December 1, DHCS is sending text messages and allowing plans to conduct their own outreach earlier to ensure members receive timely information.​​ 
• A member asked DHCS to continue exploring whether pregnant individuals, who may remain in managed care this calendar year, could have the option next year to choose between managed care and FFS, especially given differences in access to specialists, academic medical centers, and gender‑affirming care. They emphasized the need for strong specialist engagement in outreach efforts, noting that clinics alone may not meet all care needs. DHCS acknowledged the concerns and shared that recent analyses show academic medical centers, where many specialists practice, are largely FFS‑ready and are being prioritized for activation. DHCS also clarified that pregnant and postpartum individuals covered under CHIPRA 214 (those within the five‑year bar) are not affected by the transition and may stay in managed care, while other pregnant individuals will transition to FFS. They further noted that CHIPRA‑covered children remain in managed care for technical reasons related to their eligibility category, even though they do not appear on the slide referenced.​​ 
• A member thanked DHCS for convening the discussion and highlighted that their primary concern is what happens to current Medi-Cal members when the system responsible for their care changes around them. They appreciated efforts, such as early text messaging, provider analysis, risk stratification, and the command center approach, but emphasized the significant gap between the 151,000 managed care providers currently serving UIS members and the much smaller portion meaningfully active in FFS, stressing that enrollment alone does not guarantee true capacity, especially across geography, specialty, and language needs. Drawing on past FFS experience, the member warned that the January 1 transition represents a major backward shift in care integration, especially for children with California Children’s Services (CCS) conditions whose care will become fragmented across multiple systems. They urged DHCS to measure actual access rather than provider enrollment, preserve continuity of care by maintaining existing authorizations, and establish clear escalation pathways for families, emphasizing that transitioning UIS members remain part of their communities and that the system’s success depends on protecting them through a safe, coordinated transition.​​ 
• A member thanked DHCS and emphasized the high stakes of the January 1 transition of approximately 2 million UIS Medi‑Cal members, noting California had other compliance options (including a Local Health Plans of California proposal) and warning that FFS is not designed to support access. With budget savings premised on reduced utilization, they urged stronger planning for provider capacity as FFS enrollment scales by more than 300%, asked for an expedited enrollment pathway and outreach to roughly 45,000 enrolled but inactive providers, questioned the “transition risk” categorization given large cohorts needing specialty care, dialysis, and behavioral health, and requested details on the statewide care coordination vendor and how it will work with plans. DHCS responded that its stratification measures transition risk, not clinical risk; would share definitions; is prioritizing January outreach and mitigation through provider enrollment; and will announce the vendor once contracted, coordinating referral processes with MCPs.​​ 
• A member thanked DHCS for the detailed data and raised concerns about how risk stratification connects to FFS provider readiness, noting that large numbers of providers, about 65,000, are either not enrolled or enrolled, but not meaningfully active in FFS, which creates uncertainty about capacity and continuity of care. They emphasized the need for expedited or single‑case provider enrollment, stronger notice requirements for plans, and better support for community‑based organizations so members not currently engaged in clinics can still access assistance. The member also sought clarity on how DHCS interprets high‑, medium‑, and low‑urgency groups, the implications of 650,000 members with no claims history, and how many in each category may face loss of care on January 1. DHCS responded that the high‑transition‑risk category reflects members whose current providers are either not enrolled or not billing FFS, meaning they may not be able to continue care without intervention. DHCS explained that its current focus is on activating providers, enrolling those not yet enrolled, and proactively contacting both providers and members to mitigate gaps. They also described “hot spotting” at the neighborhood level to identify high‑risk providers, developing enrollment and billing toolkits for plans to distribute, and coordinating with plans to ensure targeted outreach ahead of January.​​ 
• A member thanked DHCS for convening the meeting and asked when MCPs would be allowed to share lists of members transitioning on January 1 so providers can prepare patients for potential service disruptions. They also requested clarification on how existing prior authorizations would be treated during and after the transition, emphasizing the need to avoid delays in care and to simplify Treatment Authorization Request (TAR) processes to support both providers and FFS enrollment. Additionally, the member asked whether future iterations of DHCS’ provider tool will show which providers are accepting new patients and how DHCS plans to identify and address regional access gaps. DHCS responded that upcoming updates to the transition guide will clarify member‑communication expectations; existing managed care authorizations will carry over through a simplified eTAR process requiring no medical documentation; and plans will submit weekly, and later daily, authorization files to support seamless approvals. DHCS noted that future enhancements will allow the provider tool to show whether providers are accepting new patients, while care coordination supports and expanded monitoring of access and provider participation will be built out as the transition approaches.​​ 
• A member asked whether individuals in long‑term care settings are included in the high‑urgency transition‑risk category, emphasizing the need for early provider notification, well before the 30‑day window, to prevent care disruptions and allow facilities to coordinate care across multiple provider types. They stressed that without timely identification of which residents are transitioning, long‑term care providers may face significant administrative burdens and be unable to prepare appropriately. DHCS responded that only a very small number of long‑term care residents fall into the high‑risk category because most long‑term care facilities already participate in and bill Medi‑Cal FFS; however, for the small subset affected, DHCS is validating National Provider Identifier information and conducting targeted outreach. DHCS also noted that its transition guide directs MCPs to notify skilled nursing facilities and reinforces their legal obligation to maintain continuity of care for residents during the transition.​​ 
• A member asked how DHCS determines whether providers counted as “active” in FFS are truly prepared to take on new patients, especially specialists who may be reluctant due to lower fee schedule reimbursement, and how DHCS assesses their actual capacity beyond simply having submitted at least one FFS claim. They also sought clarification on how continuity of care will function, asking whether clinical conditions determine eligibility and whether DHCS will require non‑enrolled providers to be paid in FFS to maintain existing relationships for high‑need patients. DHCS explained that “active” status is based only on whether a provider is enrolled and has billed FFS, and that capacity assessments must be done through targeted outreach rather than data. They emphasized that continuity of care hinges entirely on whether a provider is enrolled in Medi‑Cal FFS; if not enrolled, they cannot bill and cannot continue care under FFS, regardless of clinical need. Transition‑risk scoring combines clinical factors with provider enrollment status to identify members most at risk of losing access, and DHCS is focusing outreach on high‑risk providers and counties to encourage enrollment and reduce disruptions ahead of January.​​ 
• A member raised concerns about specialty care access under FFS, asking whether hot spotting efforts cover specialist providers, whether any network‑adequacy standards will apply to FFS, including in rural areas, and when Federally Qualified Health Centers (FQHC) can expect detailed billing guidance as they prepare for major operational changes. They emphasized that FQHCs play a critical role in serving UIS members and flagged concerns about relying heavily on them while Prospective Payment System (PPS) payments for this population are scheduled to end next year. DHCS responded that its analytics are expanding to examine specialty care access by county and provider type; standards for FFS access and availability are still being built for 2027; and rural access needs are part of current planning. DHCS added that FQHC billing in FFS remains largely unchanged aside from new care management codes, and PPS payments will continue for this population through June 30, 2027.​​ 
• A member outlined a scenario in which a patient arrives at the emergency room (ER) unaware of whether they are in FFS or managed care, and the ER must stabilize them, but may need inpatient admission or a safe outpatient follow‑up plan. They expressed concern about timely access to needed services, potential delays in care transitions, and the risk of ER overcrowding if providers cannot quickly identify FFS resources or arrange outpatient continuity. DHCS responded that most hospitals are already FFS‑ready for inpatient admissions, so those transitions should be straightforward. The larger challenge is ensuring smooth transitions from the ER back to outpatient care, and DHCS is actively designing processes to give ERs clear information about FFS providers and a direct contact point, via DHCS or the care management vendor, to coordinate follow‑up. Developing these tools and support pathways is a core focus of DHCS’ ongoing implementation work.​​ 
• A member asked whether Kaiser would function as an FFS provider during the UIS transition and if DHCS could require this given its statewide contract. DHCS responded that Kaiser will continue serving members who transition into FFS, and DHCS is actively working with Kaiser to ensure those members can remain with their Kaiser providers. DHCS emphasized that this applies to Kaiser as a provider, not as a plan, and that Kaiser physicians will bill Medi‑Cal FFS following standard processes. DHCS noted that Kaiser is already enrolled as a provider, which helps preserve continuity of care while DHCS finalizes the operational details and requirements needed to support the transition.​​ 

Pampublikong Komento​​ 

During the public comment period, participants shared concerns and provided feedback to DHCS and panel members in writing.​​ 

• A member of the public provided a written statement urging DHCS to strengthen protections for Medi-Cal members with UIS who will transition from managed care to FFS in 2027, warning that many may lose established behavioral health providers and critical coordination services, such as Enhanced Care Management (ECM) and Community Supports. The WeBelong Institute recommended requiring a comprehensive behavioral health continuity plan that proactively identifies all affected members receiving mental health or substance use disorder services; verifies that each current provider is truly enrolled and available in FFS; preserves existing treatment and authorizations long enough for a safe, clinically appropriate transition; ensures equivalent navigation support for those losing managed care‑based coordination; delivers trauma‑informed, multilingual notices that clearly explain members’ rights and options; and publicly reports key access and continuity metrics. The comment emphasized that the transition’s success should be measured by uninterrupted access to appropriate care, not merely by administrative completion of notices and data transfers.​​ 
• A member of the public representing Health Linkages provided a written statement expressing deep concern that many Medi‑Cal members with UIS are unaware of the upcoming transition to FFS and will not understand how it affects their providers, behavioral health services, transportation, or care coordination. They warned that community outreach capacity is insufficient, many smaller providers are unprepared or not enrolled in FFS, and the result may be delayed or foregone care as members lose continuity, face long waitlists, or stop seeking routine services. To reduce harm, they urged DHCS to ensure multilingual plain language notices truly reach members; clarify how and when DHCS will verify successful communication; expand technical assistance to small and behavioral health providers; establish a clear process for identifying and responding to access problems; and provide timely funding and guidance for community-based organizations, promotores, and community health workers well before January 1, so trusted messengers can begin outreach and navigation support immediately.​​ 
• A member of public provided a written statement urging DHCS to thoroughly evaluate all options to allow Medi-Cal members to remain in managed care whenever possible, emphasizing that doing so would prevent care disruptions, protect timely access to providers, and preserve essential supports, such as care coordination, ECM, and Community Supports. The commenter expressed appreciation that DHCS is prioritizing continuity of care for children, youth, and pregnant people, and encouraged DHCS to maximize managed care retention to maintain stability and comprehensive services for affected members.​​ 

Pagpapaliban at Paparating na Pagpupulong ng SAC/BH-SAC​​ 

Pinasalamatan ng DHCS ang mga miyembro ng komite at ang publiko para sa kanilang pakikilahok bago nagbigay ng paalala para sa nalalapit na pagpupulong.​​ 

• The next meeting is scheduled for October 28, 2026. Register here.​​ 
• Ang Joint SAC/BH-SAC ay magpapatuloy na maging hybrid hanggang sa susunod na abiso.​​