On January 1, 2027, California will move Medi-Cal members with what the state calls Unsatisfactory Immigration Status (UIS) out of Medi-Cal managed care plans and into Medi-Cal Fee-for-Service (FFS). The California Department of Health Care Services (DHCS) says about 2 million members will be affected, and that the change affects how they get care, not whether they are covered.

For medical transportation, though, "how" matters a great deal. Today, Medi-Cal members in a health plan arrange covered rides through the plan or its transportation broker. After the transition, affected members will no longer have a plan to call. This guide explains what is changing, who is affected, what it means for wheelchair, stretcher and ambulance rides, and the steps patients, families and facilities can take before January.

The short version: Affected members keep full-scope Medi-Cal if they renew on time, and rides are still a covered benefit. But they will need providers (including transportation providers) that are enrolled in Medi-Cal Fee-for-Service, they may need a new medical form from a Fee-for-Service doctor, and approvals will go through DHCS instead of a health plan.

What Is Changing on January 1, 2027

In managed care, a Medi-Cal health plan coordinates a member's benefits, has its own network of providers, and handles authorizations. In Fee-for-Service, Medi-Cal pays providers directly for each visit or service, members choose any provider that accepts Medi-Cal FFS, and, in DHCS's words, "Your Medi-Cal benefits are usually not coordinated for you."

According to DHCS, the reason is federal: under new federal guidance, federal Medicaid funding for members with UIS is only allowed for emergency services that are actually furnished, and the monthly "capitation" payments the state makes to managed care plans do not qualify. To keep federal funding, California is moving these members to FFS, where providers are paid per service.

DHCS's member materials stress three points:

Who Is Affected

DHCS lists these groups as affected by the transition:

DHCS says U.S. citizens, green card holders who have been in the U.S. for five years or longer, CHIPRA 214 pregnant or postpartum members, and members enrolled in the Program of All-Inclusive Care for the Elderly (PACE) are not affected.

In preliminary data presented in September 2026, DHCS counted 1.93 million members with UIS, of whom 1.21 million had used services through managed care in the prior 12 months. Los Angeles County had by far the largest number of those members (roughly a third of the 1.21 million statewide, based on DHCS's county chart), followed by Orange County. Kern County also appears among the 12 counties DHCS charted.

What Happens to Medi-Cal Rides

The good news first: transportation remains a Medi-Cal benefit in Fee-for-Service. DHCS's provider toolkit says FFS members have access to transportation to and from Medi-Cal covered services, including medical, dental, mental health and substance use disorder treatment appointments, and trips to pick up prescriptions and medical supplies. Its member FAQ puts it simply: "You may still get rides."

Medi-Cal covers two kinds of rides, and both continue:

What changes is the path to a ride:

1. The transportation provider must be enrolled in Medi-Cal FFS

DHCS is explicit: "Just like medical providers, transportation providers must be enrolled in Medi-Cal FFS to continue serving impacted members after January 1, 2027." A ride company that only works through a health plan's broker network cannot bill Medi-Cal FFS for these members unless it is enrolled.

2. A new form from a Fee-for-Service doctor may be needed

NEMT rides require medical documentation showing that a wheelchair van, stretcher van or ambulance is medically necessary. DHCS's member FAQ warns that members "might need a form from your new Medi-Cal Fee-for-Service doctor." If a patient's current doctor does not accept Medi-Cal FFS, the form will have to come from one who does. Our guide to the Physician Certification Statement (PCS) explains what that kind of form must include.

3. Approvals move from the health plan to DHCS

In FFS, providers submit Treatment Authorization Requests (TARs) to DHCS when an authorization is required. To prevent delays, DHCS says it will implement a special handling option: when DHCS already has a health plan's approval on record for a service and an FFS provider requests a new authorization for the same service, the provider will still submit an electronic TAR, but supporting medical attachments will not be necessary. Starting November 1, 2026, DHCS will accept TARs for affected members for dates of service on or after January 1, 2027.

4. No plan care manager to coordinate

Managed care programs that many complex patients rely on, including Enhanced Care Management, Community Supports, Complex Care Management and Transitional Care Services, are not available in FFS. DHCS says it is adding a Medi-Cal FFS Nurse Advice Line and clinic- and community-based navigators beginning in January 2027, and that it is contracting with a vendor for statewide care coordination focused on members with the highest clinical risk. Even so, families who have leaned on a plan care manager to line up appointments and rides should expect to take on more of that coordination themselves, along with the clinic, hospital or facility discharging the patient.

Why Recurring Rides Deserve Attention First

A missed one-time appointment is a problem. Missed rides to recurring treatment, such as dialysis, can put a patient's health at serious risk. DHCS's own risk analysis points in the same direction. In preliminary September 2026 figures, DHCS identified 16,287 members with the most urgent continuity-of-care risk, plus another 278,673 who have an active problem, "like dialysis, at a not-ready facility or withdrawal-risk medications with an exposed prescriber," that requires active management. DHCS's analysis looks at whether patients' current providers are ready for FFS, not at transportation specifically, but in our view patients who travel to treatment several times a week have the least room for a gap.

If a patient rides to dialysis, chemotherapy, wound care or physical therapy several times a week, the transportation arrangement should be confirmed well before January 1: a Fee-for-Service doctor, a current medical-necessity form, any required authorization, and a transport provider enrolled in Medi-Cal FFS.

Members With Both Medicare and Medi-Cal

Some affected members also have Medicare and are enrolled in a "Medi-Medi Plan." DHCS says that because these members will no longer be in a Medi-Cal health plan, they will leave their Medi-Medi Plan on January 1, 2027. They can use Original Medicare or choose another Medicare plan. Medicare and Medi-Cal may cover BLS ambulance transport when it is medically necessary and authorized, and wheelchair and stretcher vans are generally not covered by Original Medicare, so it is worth reviewing how a dual-eligible patient's rides will be covered, including whether Medi-Cal will cover a wheelchair or stretcher van that Original Medicare does not. DHCS points these members to 1-800-MEDICARE or California's Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.

What This Means for the Medical Transportation Industry

Los Angeles and Orange Counties have the largest numbers of affected members in the state, so this change will be felt across Southern California's transportation providers. Based on DHCS's materials, here is how we expect it to play out:

This transition is also only one of several Medi-Cal changes on the 2027 calendar. DHCS's timeline shows federal H.R. 1 work requirements for Medi-Cal expansion adults starting in January 2027 and six-month renewals for expansion adults beginning in March 2027. For any member, missing a renewal can mean losing coverage, including the transportation benefit. Our guide to Medi-Cal work rules and six-month renewals explains who is affected.

A Checklist Before January 1, 2027

For patients and families

  1. Ask every doctor and clinic: "Do you take Medi-Cal Fee-for-Service?" If not, find one who does using DHCS's Find Doctors and Services tool or the Medi-Cal Help Line at 1-800-541-5555.
  2. Ask about your medical transportation form. If you use a wheelchair van, stretcher van or ambulance, ask your FFS doctor whether a new form is needed.
  3. Confirm your ride provider is enrolled in Medi-Cal FFS before your first appointment in January.
  4. Keep your Medi-Cal BIC handy. Your plan card will not work starting January 1.
  5. Call the Help Line about equipment. DHCS asks members who use a wheelchair, walker or oxygen to call 1-800-541-5555 so the equipment stays covered.
  6. Update your contact information and renew on time. DHCS plans to send notices to affected members by December 1, 2026. Keep your address and phone number current with your county office or BenefitsCal, and note that your health plan's call center can still help through December 31, 2026.

For hospitals, SNFs, dialysis centers and clinics

  1. Flag affected patients with recurring rides and confirm their January transportation now.
  2. Verify eligibility the FFS way. DHCS directs providers to check eligibility with the BIC through its Automated Eligibility Verification System (AEVS) at (800) 456-2387 or a point-of-sale device.
  3. Submit TARs to DHCS (starting November 1, 2026) for services that need authorization on or after January 1, 2027, and use the special handling option when a plan approval already exists.
  4. Make sure medical-necessity forms come from FFS-enrolled clinicians and match the level of transport needed.
  5. Confirm your transport partners are enrolled in Medi-Cal FFS so discharges are not delayed.

How West Coast Ambulance Can Help

West Coast Ambulance provides wheelchair and stretcher transportation across Los Angeles, Orange and Kern Counties, and BLS ambulance and critical care transport in Los Angeles and Orange Counties. If you are not sure how a patient's rides will work after January 1, call our dispatch team at 800-880-0556. We answer 24/7/365, and we can check a patient's insurance benefits for free before a scheduled trip. Facilities can also reach our team through the For Facilities page. For a broader overview of how Medi-Cal transportation works, see our guide, Does Medi-Cal Cover Medical Transportation?

Frequently Asked Questions

Who is moving from Medi-Cal managed care to Fee-for-Service in 2027?

Starting January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status move from Medi-Cal managed care plans to Medi-Cal Fee-for-Service. DHCS says this includes undocumented members (including children and pregnant members), green card holders in the U.S. for less than five years, people who are Permanently Residing Under Color of Law (PRUCOL), and qualified non-citizens who lose federal full-scope eligibility under H.R. 1. DHCS estimates about 2 million members are affected.

Will Medi-Cal still cover rides to medical appointments after the switch to Fee-for-Service?

Yes. DHCS says Fee-for-Service members have access to transportation to and from Medi-Cal covered services, including Non-Emergency Medical Transportation (ambulance, wheelchair van or stretcher van when medically necessary) and Non-Medical Transportation for members with no other way to get to an appointment. Members may need a new form from a Fee-for-Service doctor, and the transportation provider must be enrolled in Medi-Cal Fee-for-Service.

Do I need a new card for Medi-Cal Fee-for-Service?

No new card is being mailed. Starting January 1, 2027, affected members use their existing Medi-Cal Benefits Identification Card (BIC) instead of their health plan card, which will no longer work. A lost or damaged BIC can be replaced through the county Medi-Cal office or BenefitsCal.

Will affected members have to pay for care in Fee-for-Service?

No. DHCS says Fee-for-Service does not mean members pay; Medi-Cal still covers the cost of care. Members keep full-scope Medi-Cal as long as they renew on time.

What services are lost in Medi-Cal Fee-for-Service?

Affected members lose access to managed care services that are not available in Fee-for-Service, including Enhanced Care Management, Community Supports, Complex Care Management and Transitional Care Services. DHCS says members can still get services such as chronic care management, doula services and Community Health Worker services in Fee-for-Service, and it is adding a Nurse Advice Line and navigators beginning in January 2027.

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