California updated several Medi-Cal payment rates for the 2026–2027 fiscal year. The California Department of Health Care Services (DHCS) released new behavioral health fee schedules on July 1, 2026.
Other provider rates are changing too, through separate state plan amendments.
This guide breaks down what changed, what stayed the same, and where to find exact payment amounts.
If you’re a provider, a billing staff member, or a Medi-Cal member trying to understand your coverage, this article covers the key updates in plain language.
Not every rate has a single, unified fee schedule. DHCS spreads updates across several programs and documents. We’ll point you to each one.
Article Summary
- DHCS published new Behavioral Health Fee Schedules for FY 2026–27, effective July 1, 2026.
- Primary care, OB, and mental health rates stay at the CY 2024 Targeted Rate Increase (TRI) level, set at no less than 87.5% of Medicare.
- Several State Plan Amendments (SPAs) propose changes to lab, hospital, and psychiatric inpatient rates for 2026–27.
- Long-Term Care provider rates for 2026 took effect January 1, 2026.
- No single “Medi-Cal Physician Fee Schedule 2026–2027” document exists yet. Rates come from separate sources.
- Managed care capitation rates are posted on California’s Open Data Portal, not on the main DHCS rate pages.
What Is the Medi-Cal Fee Schedule?
The Medi-Cal fee schedule lists how much the state pays providers for specific medical services. Each service has a code and a dollar amount attached to it.
DHCS updates these rates through several channels each year. Some changes apply to fee-for-service (FFS) billing. Others apply to managed care plans, which negotiate separately with providers.
Understanding your fee schedule matters if you’re billing Medi-Cal directly or checking whether your reimbursement matches current rates.
Behavioral Health Fee Schedules for FY 2026–27
DHCS published the full set of Medi-Cal Behavioral Health Fee Schedules for State Fiscal Year 2026–27, effective July 1, 2026. These cover payments made to Mental Health Plans and county-run programs, not individual providers directly.
The schedules split into three main categories, each covering different types of behavioral health services.
Specialty Mental Health Services (SMHS)
SMHS fee schedules reimburse Mental Health Plans for a range of services. These include:
- 24-Hour Services
- Day Services
- Mobile Crisis
- Outpatient services (revised July 24, 2026)
- Psychiatric Inpatient care
- Therapeutic Foster Care
- BH CONNECT Monthly Services
Drug Medi-Cal Organized Delivery System (DMC-ODS)
DMC-ODS fee schedules reimburse counties that operate organized substance use disorder treatment systems. Covered services include:
- 24-Hour Day Services
- Ambulatory and Inpatient Withdrawal Management
- Mobile Crisis, Outpatient, and Partial Hospitalization
- Narcotic Treatment Program (NTP) Rates
- Supported Employment Services
Drug Medi-Cal (Non-ODS Counties)
Counties that haven’t adopted the ODS model use a separate fee schedule covering the same general service types: 24-hour day services, mobile crisis, outpatient withdrawal management, partial hospitalization, NTP, and supported employment.
Keep in mind these are the rates DHCS pays to plans and counties. Individual provider payment is negotiated separately and may look different.
Targeted Rate Increases: Still in Effect from 2024
California raised Medi-Cal rates for primary care, obstetric, and non-specialty mental health services starting January 1, 2024. This Targeted Rate Increase (TRI) brought applicable rates up to at least 87.5% of Medicare.
These increases apply to both fee-for-service billing and managed care network providers.
As of August 2026, no new TRI fee schedule has replaced the 2024 version. Proposition 35, passed in November 2024, made the Managed Care Organization (MCO) tax permanent. Because of this, the CY 2024 TRI fee schedule remains active until DHCS says otherwise.
Any future changes funded by MCO tax revenue require stakeholder input first. DHCS will post updates once that process wraps up.
Comparative Payment Rate Analysis (CPRA)
Federal rules under the Ensuring Access to Medicaid Services Final Rule require DHCS to publish a Comparative Payment Rate Analysis. This report compares Medi-Cal FFS rates for primary care, OB/GYN, and outpatient mental health/SUD services against other payers.
The first CPRA, covering 2025, has already been published. DHCS must release the next one by July 1, 2028, and every two years after that.
This report doesn’t set new rates by itself. It shows how current Medi-Cal payments stack up against other benchmarks, which can inform future rate decisions.
Proposed State Plan Amendments for 2026
DHCS has issued several public notices in 2026 proposing changes to specific payment methodologies. These State Plan Amendments (SPAs) are still moving through the approval process, so final rates may shift before they take effect.
Below are the key proposals relevant to 2026–27 payment rates.
| SPA Number | What It Changes | Effective Date |
|---|---|---|
| SPA 26-0019 | Clinical laboratory service reimbursement rates | July 1, 2026 |
| SPA 26-0020 | Diagnosis Related Group (DRG) payment methodology | SFY 2026–27 |
| SPA 26-0021 | Ground Emergency Medical Transportation (GEMT) Quality Assurance Fee renewal | July 1, 2026 – June 30, 2027 |
| SPA 26-0029 | Supplemental payments for primary and specialty care | Notice released June 30, 2026 |
| SPA 26-0017 | Acute Psychiatric Inpatient Hospital rate updates | Pending |
These amendments require approval from the Centers for Medicare & Medicaid Services (CMS) before they’re final. Some details may still change.
Long-Term Care and Other Provider Rates
Long-Term Care (LTC) provider rates for Calendar Year 2026 are already available. They apply to dates of service on or after January 1, 2026.
DHCS also maintains separate rate pages for:
- Medi-Cal Managed Care Rates
- Medi-Cal Provider Rates (general FFS)
- AB1629 Reimbursement Rates (skilled nursing)
- Clinical Laboratory Rates
- Medi-Cal Pharmacy Rates and Pricing
Each of these pages links to the underlying rate files, which include the specific dollar amounts by code.
What’s Not Yet Finalized
A few things remain unsettled as of August 2026:
- There’s no single combined physician fee schedule for 2026–27. Rates come from TRI updates, SPA changes, and behavioral health schedules separately.
- Exact dollar amounts for most physician CPT codes aren’t summarized publicly. You’ll need to check the linked fee schedule files directly.
- Managed care capitation rates for 2026–27 exist on the California Health and Human Services Open Data Portal, but full rate tables aren’t shown on the main DHCS overview pages.
If your household is trying to figure out whether you qualify for Medi-Cal in the first place, it helps to compare your income against the current Medicaid income limits by state in 2026 before digging into provider payment details.
How to Find Exact Fee Schedule Amounts
If you need code-level payment data, go directly to these DHCS sources:
- DHCS Rates Hub – the central starting point for all Medi-Cal rate categories.
- Behavioral Health FY 2026–27 fee schedules – includes downloadable PDF and Excel files with SMHS, DMC-ODS, and Drug Medi-Cal rates.
- Targeted Rate Increases page – links to the CY 2024 TRI fee schedule still in effect.
- 2026 SPA public notices – includes attachments with proposed rate changes for lab, DRG, and psychiatric inpatient services.
Providers checking eligibility for a specific patient can also use a Medicaid eligibility calculator in 2026 to confirm coverage before billing.
Federal vs. State Rules: Why This Matters
Medicaid is a joint federal and state program. The federal government sets baseline rules, but each state — including California — designs its own fee schedules, eligibility rules, and program names (Medi-Cal is California’s Medicaid program).
This means rates in California won’t match rates in other states. If you’re comparing options or tracking national trends, it helps to see the broader Medicaid fee schedule FY 2027 picture alongside California’s specific updates.
Frequently Asked Questions
When did the new Medi-Cal behavioral health fee schedule take effect?
The FY 2026–27 Behavioral Health Fee Schedules took effect July 1, 2026. The outpatient schedule was later revised on July 24, 2026.
Are Medi-Cal primary care rates increasing in 2026?
No new increase has been announced. Rates remain at the CY 2024 Targeted Rate Increase level, set at 87.5% of Medicare, as of August 2026.
Where can I find exact Medi-Cal payment amounts for my CPT code?
Check the DHCS Rates Hub or the specific fee schedule linked to your service type, such as behavioral health, lab, or managed care rates.
Do Medi-Cal managed care plans use the same rates as fee-for-service?
Not always. Managed care plans negotiate their own provider payments, though Targeted Rate Increases apply to both FFS and managed care network providers.
What is the Comparative Payment Rate Analysis (CPRA)?
It’s a federally required report comparing Medi-Cal FFS rates to other payers for primary care, OB/GYN, and mental health/SUD services. The next one is due by July 1, 2028.
Are the 2026 State Plan Amendments final?
No. They’re still pending CMS approval as of August 2026. Some rate details could change before final implementation.
Final Thoughts
California’s Medi-Cal fee schedule for 2026–2027 isn’t one single document. It’s a mix of updated behavioral health rates, a holdover Targeted Rate Increase from 2024, and several pending State Plan Amendments.
If you bill Medi-Cal or rely on it for coverage, check the DHCS Rates Hub directly for the most current numbers tied to your specific service type.
