California legislation · 2025-2026 Regular Session
California AB1126: Medi-Cal managed care plans: enrollees with other health care coverage.
Status: Chaptered, September 14, 2026
What the bill says
An act to add Section 14197.85 to the Welfare and Institutions Code, relating to Medi-Cal. Medi-Cal Medi-Cal managed care plans: enrollees with other health care coverage. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions…
From the chaptered text, September 14, 2026:
An act to add Section 14197.85 to the Welfare and Institutions Code, relating to Medi-Cal. Medi-Cal Medi-Cal managed care plans: enrollees with other health care coverage. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing federal law, in accordance with third-party liability rules, Medicaid is generally the payer of last resort if a beneficiary has another source of health care coverage in addition to Medicaid coverage. This bill would require the department, in the case of a Medi-Cal managed care plan enrollee who also has other health care coverage and for whom the Medi-Cal program is a payer of last resort, to ensure that a provider that is not contracted with the plan and that is billing the plan for Medi-Cal allowable costs not paid by the other health care coverage does not face administrative requirements significantly in excess of the administrative requirements for billing those same costs to the Medi-Cal fee-for-service delivery system. Under the bill, in the case of an enrollee who meets those coverage criteria, except as specified, a Medi-Cal fee-for-service provider would not be required …