ACCMA News

Two Million Medi-Cal UIS Patients Transitioning to FFS

Two Million Medi-Cal UIS Patients Transitioning to FFS 

Updated September 29, 2026 

ACCMA hosted a “townhall” meeting on September 24th with our local Medi-Cal managed care plan CEOs about a significant change in how approximately 2 million Californians receive care. 

Beginning January 1, 2027, Medi-Cal patients with “unsatisfactory immigration status” (UIS) will transition from managed care to the Medi-Cal fee-for-service (FFS) system. The transition follows 2025 federal guidance that California has interpreted as prohibiting this population in Medicaid managed care risk-based contracts. 

Affected patients will remain enrolled in Medi-Cal, but their medical care will no longer be provided through their managed care plan or its network. To continue caring for these patients, physicians must have the appropriate Medi-Cal FFS enrollment and be prepared to use its billing and authorization processes. 

If you missed last week’s discussion or would like to revisit the information presented: 

Watch the meeting recording: 

• Zoom Recording 
• Passcode: eJLt?04. 

View the presentation slides:  

• Alameda Alliance for Health   
• Contra Costa Health Plan   

What Physicians Should Do Now 

1. Verify your Medi-Cal fee-for-service enrollment 

Participation in a Medi-Cal managed care network does not necessarily mean you are ready to provide and bill for FFS services. Confirm that you are actively enrolled under your individual Type 1 National Provider Identifier (NPI), with the appropriate enrollment to support reimbursement for the care you provide. 

If enrollment is needed, apply promptly through the Provider Application and Validation for Enrollment (PAVE) system. Physician enrollment applications can take up to 90 days to process. 

An ordering, referring and prescribing (ORP)-only enrollment does not authorize reimbursement for services you provide directly to patients. Physicians planning to treat patients transitioning to FFS should ensure their enrollment supports the ability to bill for services.  

2. Prepare your billing and authorization processes 

Beginning January 1, services provided to affected patients will no longer be reimbursed under your managed care contract. Claims will instead be submitted through the Medi-Cal FFS system and paid according to the Medi-Cal FFS fee schedule.  

Review these changes with your billing staff or billing service, including claims submission procedures, applicable payment rates and Treatment Authorization Request (TAR) requirements. Do not assume that managed care billing or authorization procedures will carry over to FFS. 

3. Coordinate with health plans to protect continuity of care 

DHCS is requiring managed care plans to communicate with contracted providers serving affected patients about the transition, enrollment requirements and steps to maintain continuity of care. 

Practices should review plan communications, identify patients whose ongoing care may be disrupted and seek guidance on pending authorizations, referrals and treatment extending into 2027. Give particular attention to patients receiving complex treatment or relying on multiple providers. Monitor the DHCS transition webpage for additional implementation guidance. 

Alameda Alliance Provider Relations: 510-747-4510 or providerservices@alamedaalliance.org  

CCHP Provider Relations: 877-800-7423, option 6 or Online

4. Help patients understand what is changing 

Patients should understand that this transition changes how they access care; it does not, by itself, end their Medi-Cal eligibility. They will need providers who accept Medi-Cal FFS and should renew/revalidate their coverage on time. 

Let affected patients know whether your practice will continue seeing them through FFS. Remind them to bring their Medi-Cal Benefits Identification Card to appointments beginning January 1, rather than relying on their managed care plan card. 

DHCS has posted patient notices, outreach materials and other resources on its transition webpage. Patients needing help finding an FFS provider can call the Medi-Cal Help Line at 1-800-541-5555. 

Additional FFS Requirements to Review 

Keep your provider directory information current 

With more patients seeking FFS providers, accurate directory information will be especially important. Enrolled FFS providers must review and update their directory information at least quarterly - in January, April, July and October. The next review is due in October. 

Required information includes office phone numbers, acceptance of new patients, telehealth availability, languages, disability accommodations and a website, if available. 

• Billing providers should use the Medi-Cal Provider Portal, selecting “Manage Organization” and then “Public Fee-for-Service Provider Directory.” Organization Administrator or NPI Administrator permissions are required. 

• Individual non-billing providers should complete the Provider Directory Survey linked on the DHCS directory requirements webpage. 

Updating your enrollment record in PAVE does not satisfy this separate directory requirement. 

Prepare for ordering, referring and prescribing enrollment enforcement 

Separately, DHCS will begin phased enforcement of Medi-Cal ORP enrollment requirements in February 2027. Physicians and other eligible practitioners who order, refer or prescribe services for Medi-Cal patients must be enrolled under their individual Type 1 NPI; an organizational Type 2 NPI does not satisfy this requirement. 

Physicians should verify their enrollment now. Those already enrolled under their individual NPI as a billing, rendering or other qualifying FFS provider do not need a separate ORP-only application. Those who only order, refer or prescribe may use the ORP-only pathway through PAVE. 

As CMA has reported, enforcement will vary by provider and service type, and the detailed phase schedule has not yet been publicly posted. Practices could encounter claim denials involving an unenrolled ordering or referring provider before enforcement reaches their own physicians’ ORP activity. 

See the DHCS ORP enrollment information page for instructions. Enrollment questions may be directed to ORP@dhcs.ca.gov. 

ACCMA Launches Practice Management Virtual Series

ACCMA LAUNCHES PRACTICE MANAGEMENT VIRTUAL SERIES
We are continuing our virtual ACCMA practice management series! Physicians, practice managers, and administrators are invited to join us the last Thursday of each month at 12:30 PM for discussions on the operational, financial, staffing, compliance, and patient service challenges facing today’s independent medical practices.

Understanding & Influencing Health Policy: Advocacy Training For Physicians

UNDERSTANDING & INFLUENCING HEALTH POLICY: ADVOCACY TRAINING FOR PHYSICIANS
ACCMA’s Understanding and Influencing Health Policy: Advocacy Training for Physicians program equips physicians with the knowledge, skills, and confidence to effectively engage in health policy and advocacy. Through a series of sessions led by policy experts, elected officials, and physician leaders, participants gain practical insight into how healthcare policy is shaped—and how their voices can influence meaningful change. The series is designed to be practical, engaging, and immediately applicable to your professional role.

Dr. Clifford Wong: President's Message Q3 Bulletin

CMA Position on November Ballot Initiatives

By Clifford Wong, MD, ACCMA President

Every election season brings a long list of ballot measures, some of which can have significant implications for our patients and California’s healthcare system. The California Medical Association (CMA) carefully reviews each statewide initiative and, when appropriate, takes positions to help physicians understand the potential implications. This November, CMA is opposing two healthcare-related ballot measures while supporting a third that offers a more sustainable, long-term approach to healthcare funding.

CMA is opposing Proposition 44, the Clinic Funding Accountability and Transparency Act. The measure would require Federally Qualified Health Centers and other qualifying community health clinics to spend at least 90 percent of their annual expenditures on defined program services, with financial penalties for clinics that fail to meet the requirement. Transparency and accountability are important principles, and CMA supports ensuring that healthcare dollars are used effectively to serve patients. However, while intended to direct more resources toward patient care, the measure reduces the flexibility clinics have to tailor services to the unique needs of the communities they serve. In addition to providing direct medical care, many clinics also provide services that improve access to care, such as transportation for patients who have no reliable way to travel to medical appointments, particularly in California's rural communities. Clinics may also provide care coordination, patient navigation, language assistance, outreach, and other supportive services that help patients receive timely and appropriate care, but may not qualify as "program services" under the measure. By imposing a rigid 90 percent spending requirement backed by financial penalties, Proposition 44 could limit clinics' ability to provide these essential services and adapt to the
changing needs of their patient population. CMA believes policy should strengthen the healthcare safety net by giving clinics the flexibility to deliver comprehensive, patient-centered care rather than imposing mandates that could inadvertently reduce access to care for the communities they serve.

CMA is also opposing Proposition 40, the Billionaires Tax Act. Proposition 40 would impose a one-time tax of up to 5 percent on the net worth of certain billionaires to fund healthcare and other public programs. While the goal of increasing funding for healthcare is an important one, the measure raises significant implementation, administrative, legal, and constitutional questions. The Franchise Tax Board is not currently equipped to administer and enforce a tax requiring valuations of complex assets, and developing the systems, regulations, and expertise needed to implement the measure would likely take years. In addition, revenue estimates are highly uncertain, with the Legislative Analyst's Office projecting substantially different revenues than those projected by the measure's proponents. It is also likely to face constitutional challenges, creating additional uncertainty regarding implementation and the timing and amount of any revenues collected. Because California's healthcare system depends on stable and predictable funding, CMA is concerned that Proposition 40 will not provide a reliable long-term funding source for critical healthcare programs. CMA has consistently supported responsible revenue measures, including Propositions 30, 55, and Proposition 3, because they provide a more stable and sustainable funding mechanism for California's healthcare system.

Instead, CMA supports Proposition 3, which would permanently extend California's existing tax rates on the state's highest-income earners. Because these revenues are already part of the state's fiscal structure, Proposition 3 would provide a more predictable, long-term funding stream for healthcare, education, and other essential public services without relying on a one-time infusion of revenue. CMA believes this approach offers greater fiscal stability and better protects the programs our patients depend on.

Reasonable people may reach different conclusions on these measures. CMA's positions are guided by a consistent principle: supporting policies that strengthen California's healthcare system, preserve access to care and provide stable, long-term investments in the health of our communities. I encourage you to learn more about these initiatives before casting your ballot this November.

ACCMA Nominating Committee 2026-2027 Slate

The ACCMA Nominating Committee is pleased to share its slate of nominees for positions up for election this year. You can view the full list in the Electoral Structure Report.

According to ACCMA Bylaws, any active member may submit additional nominations. If additional nominees are submitted, a contested election will be held by mail ballot in September between the nominee(s) and the Committee’s candidate(s).

The deadline to submit nominations is August 31, 2026.

ACCMA Launches Practice Management Series

Physicians, practice managers, and administrators are invited to join us the last Thursday of each month at 12:30 PM for discussions on the operational, financial, staffing, compliance, and patient service challenges facing today’s independent medical practices. Our next program is July 30th focused on Medical Records Basics: What Small Practices Get Wrong. Join Michael Anderson, Manager of Patient Safety & Risk Management for MIEC, as he reviews the basics of protected health information and privacy/confidentiality, what constitutes the medical record, documentation fundamentals and more.

Learn more

ACCMA Launches Resident/Fellow Leadership & Career Development

ACCMA is hosting the Resident/Fellow Leadership & Career Development Program, a weekend intensive designed to help residents and fellows build leadership skills and prepare for the transition into practice. The program will take place August 29–30 and will include networking, interactive leadership and professional development sessions, career planning discussions, engagement with physician leaders, and more. Those interested in joining the first cohort should complete the interest form.

This form is designed to gauge interest in the program—please complete it if you are interested in potentially participating in the first cohort. Further information will be provided upon submission. For more information or questions, please contact Mr. David Lopez, ACCMA Director of Education and Governance, at dlopez@accma.org.

Learn more

ACCMA Member Elected to Leadership Position at AMA HOD

Several California physicians, including ACCMA member Pauline P. Huynh, M.D., were elected to leadership positions at the recent AMA annual House of Delegates meeting. Dr. Huynh, an otolaryngologist with Kaiser Permanente Northern California in Oakland, was elected as secretary of the AMA Board of Trustees. Dr. Huynh previously served as Chair of the AMA Resident and Fellow Section, and as an officer on the CMA Resident and Fellow Section Executive Council.

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Dr. Clifford Wong: President's Message

President’s Column:

Caring for Ourselves While Caring for Others

By Clifford Wong, MD, ACCMA President

Since the month of May is Mental Health Awareness Month, it is a good reminder to acknowledge the humanity of physicians and the extraordinary pressures we are facing today. The demands of practicing medicine continue to grow more complex, while many of us are also carrying the emotional weight of challenges unfolding beyond our clinics and hospitals – economic uncertainty, rising costs of living, global conflict, political division, and the ongoing strain these realities place on our communities and families.

Physicians are often expected to be resilient in the face of constant stress, yet resilience does not mean facing these burdens alone. Many physicians across every specialty and stage of practice will experience burnout, anxiety, depression, and emotional exhaustion at some point, or points, in their careers. This is not a sign of failure, but rather a sign of our humanity. Likewise, taking care of our own mental health is not a sign of weakness, it is essential to sustaining our ability to care for others.

At ACCMA, supporting physician wellness remains a priority. Members have access to confidential resources designed specifically for physicians, including peer support, counseling referrals, wellness programming, and assistance navigating personal or professional challenges. These services exist because no physician should feel isolated when facing difficult moments.

This month serves as a reminder not only to care for our patients, but also to extend the same compassion and attention to ourselves and our colleagues. Reaching out, checking in, and seeking support when needed are acts of strength and kindness that help sustain both individual physicians and the medical profession as a whole.

For more information about physician wellness resources available through ACCMA, please visit https://www.accma.org/Membership/Physician-Wellness.

New on Demand Health Policy Advocacy Training for Physicians

We are pleased to share an overview of our upcoming Advocacy Education Series now live and on demand. This program brings together insights from advocacy experts to help physicians better understand how health policy is shaped—and how they can become effective advocates.

This series is designed to be practical, engaging, and immediately applicable to your professional role. Participants can expect:

• Real-world examples of successful physician advocacy
• Interactive discussion and opportunities for peer learning
• Practical tools and templates for communicating with policymakers
• Actionable next steps to implement in your own community

Learn how the legislative process works and what resonates with policymakers, develop effective communication strategies using clear messaging and storytelling, gain practical tools to move from identifying a problem to creating a solution, and build the confidence and skills needed to drive meaningful change for patients and communities. 

We look forward to your participation in this important and timely series. Please let us know if you have any questions. Sign up today!