CA AB974

Requires the Department of Health Care Services to ensure providers billing Medi-Cal managed care plans for patients with other health coverage do not face administrative requirements significantly greater than those for billing Medi-Cal fee-for-service

Allows Medi-Cal fee-for-service providers to bill managed care plans for allowable costs without contracting as in-network providers, when the patient has other health coverage (excluding Medicare) and Medi-Cal is the payer of last resort

Permits managed care plans to require letters of agreement for services needing prior authorization, services not covered by other insurance, or continuity of care situations

Mandates the department solicit stakeholder input on coordinating payments between commercial coverage and Medi-Cal managed care, with emphasis on regional center service recipients, and include this topic at the first 2026 Medi-Cal Managed Care Advisory Committee meeting

Requires annual updates to legislative health committees from 2026 through 2029 on implementation effectiveness, with implementation contingent on federal approvals and availability of federal financial participation