CaliforniaMedi-Cal plans would ease billing for providers serving patients with other coverage
If federal approval and funding are available, Medi-Cal managed care plans would accept certain claims from providers who are outside their networks.
What it does
Eligible providers could bill Medi-Cal managed care plans for unpaid allowable costs without facing much heavier paperwork than fee-for-service providers.
Many providers could bill a Medi-Cal plan without joining its network, but plans could still require agreements for prior approval, uncovered services, or continuity of care.
The department would clarify billing rules, offer requested coverage-coordination help, and report to lawmakers annually from 2027 through 2030.
Argument forProviders may face less paperwork and more billing access when other coverage leaves allowable Medi-Cal costs unpaid.
Argument againstRequired agreements for some services could still add steps for providers, especially when prior approval or continuity-of-care rules apply.
More detail
The department shall ensure that eligible providers do not face much greater billing requirements than they would under Medi-Cal fee-for-service. This covers noncontracted providers serving Medi-Cal managed care enrollees who also have other health care coverage and for whom Medi-Cal is the payer of last resort. The claim must seek payment for Medi-Cal-allowed costs that the other coverage did not pay. This rule applies when the department implements the section, subject to federal approval and available federal funding.
A qualifying fee-for-service provider shall not have to join a managed care plan’s network to bill the plan for covered services. This covers providers serving managed care enrollees who have other coverage, excluding Medicare, when Medi-Cal is the payer of last resort. A plan may require a letter of agreement or similar agreement for a service needing prior approval. A plan may also require an agreement when the other coverage does not cover a service that the Medi-Cal plan does cover. A plan may require an agreement when continuity-of-care rules apply. Without an agreement, the provider may be responsible for amounts above the allowable fee-for-service rate or service limits, but the provider may not bill the enrollee for those excess amounts. The network-contract exception applies when the section is implemented, subject to federal approval and available federal funding.
The department shall clarify billing conditions and report each year on how implementation is working; it may use letters and similar instructions instead of new regulations. The clarification applies to providers serving managed care enrollees who also have other health coverage, while the reports go to the Assembly and Senate health committees. The department’s clarification may include updated regulations, guidance, added reporting, or enforcement. The bill states that the department should offer education when an enrollee asks for help with continuity of care and coordinating coverage. The department shall provide annual committee updates from 2027 through 2030; implementation otherwise depends on federal approval and available federal funding.
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Where it stands
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Sep 14Chaptered by Secretary of State - Chapter 193, Statutes of 2026.Latest
- Sep 14Approved by the Governor Gavin Newsom.Became Law
- Aug 27Enrolled and presented to the Governor at 4 p.m.To Governor
- Aug 20In Assembly. Ordered to Engrossing and Enrolling.Minor
- Vote recorded Special Consent. Result: pass.Upper
- Aug 20Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0. Page 5588.).Passed Senate
- Aug 18Ordered to special consent calendar.
- Aug 13Read second time. Ordered to third reading.Minor
- Vote recorded Do pass. Result: pass.Upper
- Aug 13From committee: Do pass. (Ayes 7. Noes 0.) (August 13).Minor
- Jun 15In committee: Referred to APPR. suspense file.Minor
- Vote recorded Placed on suspense file. Result: pass.Upper
- Jun 4From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 9. Noes 0.) (June 3). Re-referred to Com. on APPR.Minor
- Jun 3
- Vote recorded Do pass, but first be re-referred to the Committee on [Appropriations] with the recommendation: To Consent Calendar. Result: pass.Upper
- May 6Referred to Com. on HEALTH.Minor
- Jan 29In Senate. Read first time. To Com. on RLS. for assignment.Minor
- Vote recorded AB 1126 Patterson Consent Calendar Second Day. Result: pass.Lower
- Jan 29Read third time. Passed. Ordered to the Senate. (Ayes 70. Noes 0. Page 3884.)Passed Assembly
- Jan 26Read second time. Ordered to Consent Calendar.Minor
- Jan 22From committee: Do pass. To Consent Calendar. (Ayes 15. Noes 0.) (January 22).Minor
- Vote recorded Do pass. To Consent Calendar. Result: pass.Lower
- Jan 13From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 15. Noes 0.) (January 13). Re-referred to Com. on APPR.Minor
- Vote recorded Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar. Result: pass.Lower
- Jan 6Re-referred to Com. on HEALTH.Minor
- Jan 5From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.Major
- 2025
- Apr 10In committee: Hearing postponed by committee.
- Mar 24Re-referred to Com. on HEALTH.Minor
- Mar 20From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.Major
- Mar 10Referred to Com. on HEALTH.Minor
- Feb 21From printer. May be heard in committee March 23.
- Feb 20Read first time. To print.Introduced
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