Medi-Cal managed care plans: enrollees with other health care coverage.

Assembly Member Patterson's proposal to streamline billing procedures for Medi-Cal managed care plans addresses administrative barriers faced by healthcare providers serving patients with multiple insurance coverage. The legislation requires the Department of Health Care Services to ensure that non-contracted providers billing Medi-Cal managed care plans for costs not covered by a patient's primary insurance do not face excessive administrative requirements compared to the fee-for-service system.

Under the measure, providers participating in Medi-Cal's fee-for-service system would no longer need to contract as in-network providers to bill managed care plans for covered services when treating patients who have other health coverage. Managed care plans could still require letters of agreement in specific circumstances, such as when services need prior authorization or are not covered by the patient's primary insurance. The bill maintains existing protections preventing providers from billing patients for costs exceeding Medi-Cal's allowable rates.

The Department of Health Care Services would gather input from stakeholders about coordinating payments between commercial coverage and Medi-Cal managed care plans, with particular attention to recipients of regional center services. Following discussion at the Medi-Cal Managed Care Advisory Committee in early 2026, the department would clarify billing conditions and provide educational resources to help enrollees understand their coverage. The department would report annually to legislative health committees from 2026 through 2029 on implementation outcomes. Federal approval and continued federal financial participation would be required for the changes to take effect.