2026 Provider Incentive Program
| Date: | December 16, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Providers |
| Type: | Informational |
| Subject: | 2026 Provider Incentive Program |
| Business: | Medi-Cal Managed Care |
Health Plan is pleased to announce the 2026 Provider Incentive Program. This program rewards eligible network Primary Care Providers (PCPs), Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) and Obstetricians/Gynecologists (OBGYNs), for promoting quality care for our members. The incentive program will be categorized into two groups as follows:
Group A: Providers with a minimum of 40,000 Health Plan members
Group B: All other providers with a minimum of 400 Health Plan members
Program guidelines and quality measures remain the same as the 2025 Provider Incentive Program and are described in the attached document. The quality measures are derived from the Healthcare Effectiveness Data and Information Set (HEDIS) and the Managed Care Accountability Set (MCAS). MCAS are performance measures that the Department of Health Care Services (DHCS) selects for annual reporting for Medi-Cal managed care health plans. Please see the attached regarding 2026 Participation Criteria, Incentivized Quality Measures, and Program Structure.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
