Article 5.7 - Medi-Cal Field Medicine

California Welfare and Institutions Code — §§ 14186-14186.3

Sections (4)

Added by Stats. 2025, Ch. 374, Sec. 3. (AB 543) Effective January 1, 2026.

For purposes of this article, the following definitions apply:

(a)“Medi-Cal managed care plan” has the same meaning as set forth in Section 14184.101.

(b)“Person experiencing homelessness,” or a variation thereof, means a person who lacks a fixed, regular, and adequate nighttime residence. This may include living in shelters, transitional housing, or places not meant for habitation, like cars or outdoors.

(c)“Field medicine” means a set of health and social services developed specifically to address the unique needs and circumstances of persons

experiencing homelessness utilizing a whole-person, patient-centered approach to provide medically necessary health care services, and to address social drivers of health that impede health care access.

(d)“Field medicine provider” means a licensed medical provider, including, but not limited to, a physician and surgeon, osteopathic physician and surgeon, physician assistant, nurse practitioner, or certified nurse-midwife, who conducts patient visits outside of the four walls of health facilities, clinics, or other locations, and instead directly on the street, in environments where persons experiencing homelessness might be, such as living in a car, recreational vehicle, encampment, abandoned building, or other outdoor areas.

§ 14186.1

Added by Stats. 2025, Ch. 374, Sec. 3. (AB 543) Effective January 1, 2026.

(a)(1) The department shall seek any federal approvals necessary to implement this article.

(2)Each section of this article shall be implemented only to the extent that any necessary federal approvals are obtained and that federal financial participation is available and is not otherwise jeopardized.

(b)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this article by means of all-county letters, plan letters, plan or provider bulletins, or similar

instructions until any necessary regulations are adopted.

§ 14186.2

Added by Stats. 2025, Ch. 374, Sec. 3. (AB 543) Effective January 1, 2026.

It is the intent of the Legislature that implementation of this article not be duplicative of implementation of other Medi-Cal provisions, including, but not limited to, those regarding community health worker services, enhanced care management, and community supports, as described in Sections 14132.36, 14184.205, and 14184.206, respectively. It is the intent of the Legislature that the field medicine-related provisions set forth in this article coexist with those other Medi-Cal benefits in order to fill significant gaps within the health care system for persons experiencing homelessness.

§ 14186.3

Added by Stats. 2025, Ch. 374, Sec. 3. (AB 543) Effective January 1, 2026.

(a)A Medi-Cal managed care plan may elect to offer Medi-Cal covered services through an in-network, contracted field medicine provider pursuant to this article.

(b)A Medi-Cal managed care plan that elects to offer Medi-Cal covered services through an in-network, contracted field medicine provider shall allow a Medi-Cal member who is experiencing homelessness to receive those services directly from an in-network, contracted field medicine provider, regardless of the member’s in-network

assignment, such as primary care provider (PCP) or independent practice association (IPA) assignment.

(c)(1) A Medi-Cal managed care plan that elects to offer Medi-Cal covered services through an in-network, contracted field medicine provider shall allow an in-network, contracted field medicine provider enrolled in the Medi-Cal program to directly refer a member who is experiencing homelessness for covered services, including specialist, diagnostic services, medications, durable medical equipment, transportation, or other medically necessary covered services, within the appropriate network of the Medi-Cal managed care plan or in-network IPA.

(2)The Medi-Cal managed care plan or IPA shall create referral and authorization mechanisms in

order to facilitate the referrals described in paragraph (1).

(d)Medi-Cal managed care plans contracting with field medicine providers pursuant to this section shall have appropriate mechanisms, procedures, or protocols to ensure timely communication between the in-network, contracted field medicine provider, the Medi-Cal member’s plan or IPA, and the member’s assigned primary care provider for purposes of care coordination and to prevent the duplication of services.

(e)(1) A Medi-Cal managed care plan shall provide a method for a Medi-Cal member to inform the Medi-Cal managed care plan online, in person, or via telephone that the member is experiencing homelessness.

(2)The

department shall inform a Medi-Cal managed care plan if a Medi-Cal member has indicated that they are experiencing homelessness based on information furnished on the Medi-Cal application.

(f)In the case of a Medi-Cal beneficiary who is experiencing homelessness and who receives services within the fee-for-service delivery system, the department shall reimburse a field medicine provider enrolled in the Medi-Cal program for providing Medi-Cal covered services.