CA AB 1126: new version, 09/14/26 - Chaptered

California AB 1126, chaptered September 14, 2026 as Chapter 193, Statutes of 2026, amends Medi-Cal managed care requirements for enrollees who also hold other health care coverage. Under existing federal third-party liability rules, Medicaid is the payer of last resort when a beneficiary has an additional source of coverage. The bill addresses the administrative burden faced by out-of-network providers seeking to bill Medi-Cal managed care plans for allowable costs not covered by that other health care coverage. The State Department of Health Care Services is required to ensure that a provider not contracted with a Medi-Cal managed care plan 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 the dual-coverage criteria is not required to contract as an in-network provider with the managed care plan in order to bill for Medi-Cal allowable costs for covered services, subject to specified exceptions. A Medi-Cal managed care plan is authorized to require a letter of agreement or similar agreement in specified 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. The Department is also required to take actions it deems necessary to clarify billing conditions for providers rendering services to dual-coverage enrollees, and is directed by legislative intent to offer educational resources to enrollees who request assistance with continuity of care and coverage coordination. The Department is required to report annually to legislative health committees from 2027 through 2030 on the effectiveness of implementing these provisions. Implementation may proceed through plan letters or similar instructions. The bill conditions all implementation on receipt of any necessary federal approvals and the availability of federal financial participation.