AB 1126 California Assembly · 2025-2026 Regular Session

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

Summary

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 to contract as an in-network provider with the Medi-Cal managed care plan in order to bill the plan for Medi-Cal allowable costs for covered health care services. The bill would authorize a Medi-Cal managed care plan to require a letter of agreement, or a similar agreement, under specified circumstances, including if a covered service requires prior authorization, or if a service is not covered by the other health care coverage but is a covered service under the plan, as specified. The bill would require the department to take the actions that it deems necessary to provide clarification regarding the conditions for billing plans to providers that render services to enrollees who also have other health care coverage. The bill would specify the intent of the Legislature that the department offer educational resources to an enrollee who needs assistance with understanding continuity of care and coordinating Medi-Cal and their other health care coverage when requested by the enrollee. The bill would require the department, annually from 2027 through 2030, to update the legislative health committees on the effectiveness of implementing these provisions. The bill would authorize the department to implement these provisions through plan letters or similar instructions. The bill would condition implementation of these provisions on receipt of any necessary federal approvals and the availability of federal financial participation.

Bill status passed both 4 of 5 stages cleared

Introduction

Feb 2025

Committee Review

Aug 2026

Assembly Passage

Jan 2026

Senate Passage

Aug 2026

Governor

Introduced Feb 20, 2025 Last action Aug 27, 2026

Maddy AI version diff · 4 comparisons

What changed between versions

08/24/26 - Enrolled → AB1126 · 1 edit

MINOR

No substantive policy changes occurred between these two versions of AB 1126. The diff reflects a reformatting from the traditional enrolled bill document layout (with page headers, signature blocks, and column formatting) to a web-based bill tracking display format. All statutory text in Section 14197.85, the Legislative Counsel's Digest, and all other substantive provisions remain identical.

TECHNICAL

The bill was reformatted from a traditional enrolled document layout (with page numbers, column headers, and formal attestation language) to a web-based display format with navigation elements. No changes to the actual statutory language or policy content.

03/20/25 - Amended Assembly → 01/05/26 - Amended Assembly · 8 edits · Jan 5, 2026

MODERATE

AB 1126 was substantially restructured between these versions. The outdoor dining pet dog provision (amending Section 114259.5 of the Health and Safety Code) was entirely removed, and a new major provision was added creating Section 14197.85 of the Welfare and Institutions Code to protect providers who treat Medi-Cal managed care enrollees that also have other health coverage (where Medi-Cal is payer of last resort). The bill's primary focus shifted from food safety to Medicaid billing protections for dual-covered patients.

Scope change

The bill's scope shifted dramatically. It previously covered two topics: (1) pet dogs in outdoor dining areas and (2) a workgroup on functional, hormonal, integrative, and metabolic health. The new version covers: (1) Medi-Cal managed care billing protections for providers treating dual-covered enrollees and (2) the same workgroup. The food safety provision was dropped entirely, and the Medi-Cal provision is now the bill's primary substantive content.

SCOPE

The entire provision allowing pet dogs in outdoor dining areas with reusable food and water containers (amending Section 114259.5 of the Health and Safety Code) was deleted from the bill.

REQUIREMENT

New Section 14197.85 requires DHCS to ensure that out-of-network providers billing Medi-Cal managed care plans for allowable costs not paid by other coverage do not face administrative requirements significantly in excess of those for billing the fee-for-service system.

Managed care plans may require a letter of agreement or similar arrangement when a service requires prior authorization, or when a service is not covered by the other health coverage but is covered under the plan. Without such an agreement, providers may be responsible for amounts exceeding the Medi-Cal fee-for-service rate.

ELIGIBILITY

Providers participating in the Medi-Cal fee-for-service system are prohibited from being required to contract as in-network with a managed care plan in order to bill that plan for allowable costs, when the enrollee also has other health coverage (excluding Medicare) and Medi-Cal is payer of last resort.

ENFORCEMENT

DHCS must take actions it deems necessary to clarify billing conditions, which may include updating regulations, providing guidance, increasing reporting requirements, and taking enforcement action.

TIMELINE

DHCS must report annually to the Assembly and Senate Health Committees from 2027 through 2030 on the effectiveness of implementing the new provisions.

TECHNICAL

Implementation is conditioned on receipt of necessary federal approvals and availability of federal financial participation, and DHCS may implement via plan letters or similar instructions without further regulatory action.

FISCAL

The fiscal committee designation changed from 'no' to 'yes,' indicating the bill now carries a fiscal impact that requires fiscal committee review.

Floor votes · Senate Aug 20, 2026 · Assembly Jan 29, 2026

How they voted

39–0

Passed · 1 other

Total votes 40

Aug 20, 2026

D Democratic30

29 Yea 1

96% Yea

R Republican10

10 Yea

100% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Amendments

Aug 20, 2026

Lower · Passed

In Assembly. Ordered to Engrossing and Enrolling.

lower

Aug 20, 2026

Upper · Passed

Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0.).

upper

Aug 13, 2026

Upper · Passed

From committee: Do pass. (Ayes 7. Noes 0.) (August 13).

upper

Jun 15, 2026

Committee

In committee: Referred to APPR. suspense file.

upper

Jun 4, 2026

Upper · Passed

From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 9. Noes 0.) (June 3). Re-referred to Com. on APPR.

upper

May 6, 2026

Committee

Referred to Com. on HEALTH.

upper

Jan 29, 2026

Lower · Passed

Read third time. Passed. Ordered to the Senate. (Ayes 70. Noes 0. Page 3884.)

lower

Jan 22, 2026

Lower · Passed

From committee: Do pass. To Consent Calendar. (Ayes 15. Noes 0.) (January 22).

lower

Jan 13, 2026

Lower · Passed

From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 15. Noes 0.) (January 13). Re-referred to Com. on APPR.

lower

Jan 6, 2026

Committee

Re-referred to Com. on HEALTH.

lower

Jan 5, 2026

Introduced

From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.

lower

Apr 10, 2025

Lower · Passed

In committee: Hearing postponed by committee.

lower

Mar 24, 2025

Committee

Re-referred to Com. on HEALTH.

lower

Mar 20, 2025

Introduced

From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.

lower

Mar 10, 2025

Committee

Referred to Com. on HEALTH.

lower

Feb 21, 2025

Lower · Passed

From printer. May be heard in committee March 23.

lower

1 primary · 0 co-sponsors