Bill > AB974

This bill addresses administrative and billing requirements for Medi-Cal (California's Medicaid program) managed care plan enrollees who have additional health care coverage. Specifically, the bill requires that providers who are not contracted with a Medi-Cal managed care plan and are billing for services not covered by the enrollee's other health coverage should not face excessive administrative burdens compared to billing the traditional Medi-Cal fee-for-service system. The bill allows providers to bill Medi-Cal managed care plans for allowable costs without being required to become an in-network provider, with some exceptions such as services requiring prior authorization or continuity of care. The legislation mandates that the California Department of Health Care Services solicit input from stakeholders about payment coordination, focusing on recipients of regional center services, and requires the department to discuss this topic at a 2026 advisory committee meeting. The department must also provide annual updates to legislative health committees from 2026 to 2029 about the implementation's effectiveness and is encouraged to offer educational resources to enrollees who need help understanding their coverage coordination. The bill's implementation is contingent on obtaining necessary federal approvals and maintaining federal financial participation, and can be implemented through various administrative communications like plan letters and bulletins.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB974