Medi-Cal Prop 35 Payments for Therapists

Last updated: August 23, 2026.

The bottom line: California DHCS has proposed extra payments for certain Medi-Cal claims with dates of service from July 1 through December 31, 2026. Some non-specialty outpatient mental-health services and behavioral-health professionals are included—but the payment is not yet guaranteed. DHCS says federal approval of State Plan Amendment 26-0029 is still pending. Read the current DHCS payment page.

For therapists, this is best understood as a possible add-on to an eligible claim, not a permanent increase to every Medi-Cal rate. Your profession, code, billing method, setting, network status, and date of service all matter.

In plain English: if an eligible Medi-Cal claim normally pays its base allowed amount, the proposal could add a separate code-specific amount to that claim. The base rate itself would not be replaced or changed by this SPA.

What Does This Mean for Mental Health Professionals?

Psychologists, licensed professional clinical counselors, licensed clinical social workers, marriage and family therapists, and certain pupil personnel services-credentialed school practitioners appear among the proposed eligible provider types in the DHCS materials. The proposal also includes a category for non-specialty outpatient mental-health services. See the SPA 26-0029 public notice.

That does not mean every claim from one of those professionals qualifies. DHCS ties the payment to specified CPT or HCPCS codes and otherwise eligible providers. The public notice also describes billing-method and setting rules, and the proposal excludes federally qualified health centers, rural health clinics, other all-inclusive or cost-based providers, and providers subject to the Clinic Upper Payment Limit.

A simple example: suppose an otherwise eligible LMFT bills a qualifying code for an August 2026 date of service. That claim could fall within the proposed window if CMS approves the SPA. The example does not prove that the particular claim qualifies, establish the add-on amount, or tell us when the money would arrive.

What Is a Supplemental Payment?

A supplemental payment is extra reimbursement layered on top of the existing payment for an eligible service. DHCS describes the proposed amount as an add-on paid per qualifying claim and says the underlying Medi-Cal base rates remain unchanged under this SPA. Read the official public notice.

• Base payment: the amount the claim would ordinarily receive under the applicable Medi-Cal payment arrangement.

• Proposed supplement: an additional amount tied to an eligible code and claim if the SPA is approved and the other requirements are met.

• Not a permanent fee-schedule reset: the current proposal covers six months of dates of service. It does not establish an ongoing increase for future periods.

What Has Been Confirmed—and What Has Not

Confirmed by DHCS

• The proposed service-date window is July 1 through December 31, 2026.

• The proposal includes non-specialty outpatient mental-health services and lists several behavioral-health provider types.

• If approved, it would apply to eligible Medi-Cal fee-for-service providers and eligible in-network providers contracted with Medi-Cal managed-care plans.

• The payment would be an add-on to the base claim payment, with exclusions for certain provider settings and payment arrangements.

Still pending or not established by the cited guidance

• Federal approval: DHCS still describes SPA 26-0029 as pending.

• Exact payment for a specific therapy code: DHCS provides a code-specific schedule, but we are not quoting a 90837, 90834, 90791, or other amount without independently verifying the relevant row.

• Payment timing and mechanics: the cited materials do not establish when a practice would receive the add-on, whether an earlier claim would be adjusted automatically, or whether payment would arrive with the original claim or separately.

• Managed-care implementation: the proposal includes eligible in-network managed-care providers, but practices should wait for instructions from each plan they bill.

Fee-for-Service and Managed Care Need Separate Tracking

For Medi-Cal fee-for-service claims, DHCS guidance and the state claim record will be the main reference points. For managed-care claims, the practice should also monitor each contracted plan because the plan may publish its own operational instructions, remittance details, or reconciliation process.

Do not assume that one plan’s instructions apply to another, or that an in-network contract by itself proves that every clinician and code qualifies. If your enrollment data need attention, Bomi’s guides explain how to create a Medi-Cal PAVE account and give your biller access in PAVE.

What Therapy Practices Should Do Now

1. Do not book the supplement as guaranteed revenue. Until federal approval and implementation details are clear, treat it as a pending reimbursement change.

2. Build a candidate-claim list by date of service. Track July 1 through December 31, 2026 separately. Include the CPT or HCPCS code, rendering provider, billing NPI and TIN, location, payer or plan, claim status, and base allowed amount.

3. Verify both the provider and the code. Compare the current DHCS eligibility information and code-specific schedule with the clinician, setting, and billing method on the actual claim. Do not rely on the license type alone.

4. Preserve remittances and claim identifiers. Save the ERA or EOB, claim-control number, line-level allowed amount, adjustment codes, and deposit reference. Those records will make a later add-on or adjustment much easier to identify.

5. Watch DHCS and each managed-care plan. Look for the federal approval status, final code schedule, effective implementation instructions, and plan-specific guidance before deciding that a missing amount is underpayment.

6. Reconcile at the claim-line level. If payments begin, compare what was expected with what was actually allowed and paid. A bank deposit alone will not tell you which service received a supplement.

What This Could Mean Beyond 2026

Confirmed: Proposition 35 dedicated managed-care-organization tax revenue to specified Medi-Cal purposes, subject to continued federal approval. This particular SPA, however, proposes a supplemental payment only for July through December 2026 dates of service. Review the DHCS Proposition 35 page.

Reasonable inference: the six-month program could give practices and policymakers useful evidence about whether targeted add-on payments reach outpatient mental-health providers. It does not guarantee that the same payment will continue in 2027. Any later period would need its own authoritative guidance.

That distinction is similar to other reimbursement changes: a law, proposal, or funding source is not the same thing as a paid claim. For an example of a state-specific rate change with different legal mechanics, see our Illinois 90837 reimbursement article.

Where Bomi Fits

Shameless plug: Bomi can build the candidate-claim ledger, monitor DHCS and plan instructions, and reconcile any Proposition 35 add-ons back to the right therapist and claim line. You should not have to reverse-engineer six months of Medi-Cal remittances after the fact.

Talk with Bomi about Medi-Cal billing and payment reconciliation.

Frequently Asked Questions

Have the Proposition 35 therapist payments been approved?

Not yet. As of August 23, 2026, DHCS says the supplemental payments remain pending federal approval of State Plan Amendment 26-0029. Practices should not treat the add-on as guaranteed revenue.

Which dates could qualify for the supplemental payment?

The proposal covers eligible services with dates of service from July 1 through December 31, 2026. That is a service-date window, not a claim-submission or payment-date window.

Do all therapists and therapy codes qualify?

No. Eligibility depends on the provider type, the specific CPT or HCPCS code, how the service is billed, the care setting, and the exclusions in the proposal. A therapist license or a July-through-December service date alone does not establish eligibility.

Would the payment apply to Medi-Cal managed care?

If federal approval is granted, DHCS says the payments apply to eligible fee-for-service providers and eligible in-network providers contracted with Medi-Cal managed-care plans. Each plan may still need to publish its own implementation instructions.

How much more will Medi-Cal pay for 90837 or another code?

DHCS publishes a code-specific fee schedule, but this article does not quote an amount because the relevant spreadsheet rows were not independently verified. Check the current DHCS schedule and payer instructions for the exact code before forecasting revenue.

Sources

• California DHCS, Medi-Cal Proposition 35 Primary and Specialty Care Supplemental Payment

• California DHCS, State Plan Amendment 26-0029 Public Notice, released June 30, 2026

This article provides general educational and billing-operations information, not legal advice or a guarantee of eligibility or payment. Confirm the current federal approval status, code schedule, provider rules, and plan instructions for each claim.