Effective January 1, 2027, Health Plan of San Mateo (HPSM) members with unsatisfactory immigration status (UIS) will transition to the Medi-Cal Fee-for-Service (FFS) delivery system. This change is due to changes in Medi-Cal eligibility requirements.
Many HPSM members and their families will be impacted by this change. As a Medi-Cal provider, HPSM wants to make sure you have the information you need to minimize harm to HPSM members and their families and help avoid disruptions in their care. Here are three important ways you can support HPSM members:
- Encourage members to check their mail and voicemail regularly and respond to communications promptly. Members affected by this change may have already been contacted via mail and automated phone calls with critical information about their health benefits. If they have not been contacted yet, encourage them to continue checking.
- Support your patients with any necessary referrals. HPSM members transitioning to FFS Medi-Cal will need transitional care plans. Schedule needed specialty care visits before January 1, 2027. Members with complex specialty needs, members currently using the Enhanced Care Management benefit, or those using Community Supports may especially be impacted by this transition.
- Refill prescriptions ahead of January 1. HPSM members transitioning to FFS Medi-Cal may not have access to a provider who can prescribe their medications. HPSM recommends providers write 90-day prescriptions with four refills, which will last a member one year, when clinically appropriate. Please note: members transitioning to Medi-Cal FFS will continue to have Medi-Cal Rx for medication coverage.
Primary care providers: please contact HPSM if you have specific questions about your assigned panel and how you can best support them. You may reach us at PSInquiries@hpsm.org.
To learn more about immigration status and changes to eligibility please visit the Department of Health Care Services (DHCS) website.
Have additional questions?
HPSM will provide additional information as DHCS finalizes transition updates, including:
- Care management applicable billing codes in Medi-Cal FFS
- Member support pathways
- Contact information for DHCS or MCP support channels
In the interim, please direct any questions to HPSM Provider Services at PSInquiries@hpsm.org.