CA AB 1126: new version, AB1126

California AB 1126, chaptered as Chapter 193, Statutes of 2026, amends the Medi-Cal program's managed care billing framework for enrollees who carry other health care coverage in addition to Medi-Cal. Under federal third-party liability rules, Medicaid is generally the payer of last resort when a beneficiary has another source of coverage, and this bill operationalizes that principle for managed care plan billing. The bill requires the California Department of Health Care Services (DHCS) to ensure that a provider not contracted with a Medi-Cal managed care plan, but billing that plan for Medi-Cal allowable costs not paid by the enrollee's other health care coverage, does not face administrative requirements significantly in excess of those applicable to billing the same costs through the Medi-Cal fee-for-service delivery system. A Medi-Cal fee-for-service provider meeting those coverage criteria is not required to contract as an in-network provider with the managed care plan in order to submit such a bill, subject to specified exceptions. A Medi-Cal managed care plan retains authority to require a letter of agreement or similar agreement in certain circumstances, including when a covered service requires prior authorization or when the service is not covered by the enrollee's other health care coverage but is a covered service under the plan. DHCS is required to provide clarification on billing conditions to providers and is directed by the Legislature to offer educational resources to enrollees requesting assistance with continuity of care and coordination between Medi-Cal and other coverage. DHCS must report annually to the legislative health committees from 2027 through 2030 on implementation effectiveness. Implementation is conditioned on receipt of any necessary federal approvals and availability of federal financial participation. DHCS may implement through plan letters or similar instructions.