Practices must prepare for new enrollment, billing, and authorization procedures while protecting continuity of care for patients receiving ongoing or complex treatment.

California physicians should prepare before Jan. 1, when approximately 2 million Medi-Cal patients will move from managed care to the state’s fee-for-service delivery system. The transition will change reimbursement, authorization procedures, and how affected patients find physicians.

The change applies to patients the state classifies as having “unsatisfactory immigration status,” or UIS. The term includes undocumented enrollees, certain lawful permanent residents within the five-year federal waiting period, and some people permitted to reside permanently under color of law.

Affected patients will retain full-scope Medi-Cal if they renew on time. However, they will leave their managed-care plans and must receive services from physicians and other providers enrolled in and accepting Medi-Cal FFS.

The change will expand the FFS population nearly fourfold. The California Department of Health Care Services reported 711,519 FFS members in March 2026 and projects approximately 2.7 million beginning Jan. 1.

Physicians who want to continue treating affected patients should confirm their enrollment through DHCS’s Provider Application and Validation for Enrollment system and verify FFS billing eligibility under the appropriate NPI and provider type. Medi-Cal will pay eligible services under its FFS fee schedule rather than the patients’ former managed-care arrangements. Services requiring authorization will use the state’s Treatment Authorization Request process.

Practices should review transition notices and patient information from managed-care plans, identify affected patients, and review active treatment plans and authorizations. Physicians who cannot continue care should arrange appropriate records transfers and help patients locate participating providers.

Continuity concerns are particularly important for primary care, pediatrics, obstetrics, oncology, and other specialties managing ongoing or complex treatment. Patients will no longer have assigned primary care physicians. Enhanced Care Management and Community Supports will not continue through FFS. However, chronic-care-management, doula, and community-health-worker services may remain available when patients and providers meet applicable coverage and billing requirements.

The transition follows federal guidance ending federal Medicaid matching funds for risk-based capitation payments made on behalf of people who do not qualify for federally funded full Medicaid benefits. California will continue providing full-scope Medi-Cal to eligible affected members, using separate state financing where federal funding is unavailable.

DHCS continues to update its implementation guidance. Physicians should review the state’s transition resources, confirm enrollment and billing procedures, and communicate with affected patients before Jan. 1.