Molina Healthcare Clinical Practice Guidelines for California
Access the policies and guidelines that Molina uses to make medical necessity decisions.
Clinical practice guidelines are designed to guide decisions about diagnosing and treating specific health conditions. These guidelines are based on scientific evidence, medical literature reviews, or established authority. All recommendations are grounded in published guidelines and do not prioritize treatments based solely on cost.
These guidelines serve as a guide for clinical decision-making, but clinicians and patients must collaborate to create individualized treatment plans tailored to each patient's unique needs and circumstances.
Molina Healthcare regularly reviews and updates these guidelines as new clinical evidence emerges. After review and necessary modifications by the Quality Improvement and Health Outcomes Committee (QI-HOC), providers are notified of any changes via fax and/or mail.
To request a copy of any guidelines, please contact Molina Provider Services.
The guidelines listed below were reviewed and adopted by the Quality Improvement and Health Outcomes Committee (QI-HOC), with approval dates indicated for 2024 and beyond. All guidelines undergo quarterly reviews and receive annual approval unless otherwise noted.
It's important to note that clinical guidelines are not used by Molina to determine benefit coverage. Instead, they are educational tools to aid clinical decision-making and are not considered a standard of care. Physicians should adapt the guidelines based on their clinical judgment.
Acute Stress and Post-Traumatic Stress Disorder (PTSD)
Molina Healthcare has adopted the guideline for Acute Stress and Post-Traumatic Stress Disorder from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: February 2024, January 2025, May 2025
You may also visit the web site below for more information.
American Psychological Association HERE.
Anxiety/Panic Disorder
Molina Healthcare has adopted the guideline for Assessment and Treatment of Children and Adolescents from the American Academy of Child & Adolescent Psychiatry.
The Clinical Practice Guideline may be accessed HERE.
Published: October 2020
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Generalized Anxiety and Panic Disorder from American Family Physician.
The Clinical Practice Guideline may be accessed HERE.
Published: August 2022
Revised: N/A
Molina approved: May 2025
Asthma
Molina Healthcare has adopted the guideline for Diagnosis and Management of Asthma (EPR-3) from the National Institute of Health (NIH): National Heart, Lung, and Blood Institute (NHLBI).
The Clinical Practice Guideline may be accessed HERE.
Published: December 2020
Revised: February 2021
Molina approved: February 2024, January 2025
Attention Deficit Hyperactivity Disorder (ADHD)
Molina Healthcare has adopted the guideline for Diagnosis, Evaluation, and Treatment of Attention-Deficit Hyperactivity Disorder in Children and Adolescents from the Journal of the American Academy of Pediatrics (AAP).
The Clinical Practice Guideline may be accessed HERE.
Published: November 2011
Revised: October 2019
Molina approved: February 2024, January 2025
Autism
Molina Healthcare has adopted the guideline for Identification, Evaluation, and Management of Children with Autism Spectrum Disorder from The American Academy of Pediatrics.
The Clinical Practice Guideline may be accessed HERE.
Published: January 2020
Revised: N/A
Molina approved: February 2024, January 2025
Bipolar Disorder
Molina Healthcare has adopted the guideline for Bipolar Disorder from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: May 2023
Revised: N/A
Molina approved: February 2024, January 2025
Cancer Treatment and Prevention
Molina Healthcare has adopted the guideline for Cancer from the American Cancer Society
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: January 2025, February 2026
Children with Special Health Care Needs
Molina Healthcare has adopted the guideline for Access to Services for Children and Youth with Special Health Care Needs from The American Academy of Pediatrics.
The Clinical Practice Guideline may be accessed HERE.
Published: June 2022
Revised: N/A
Molina approved: February 2024, January 2025
Chronic Kidney Disease
Molina Healthcare has adopted the guideline for Evaluation and Management of Chronic Kidney Disease Guideline from the National Kidney Foundation, Kidney Disease Outcome Quality Initiative (NKF KDOQI).
The Clinical Practice Guideline may be accessed HERE.
Published: March 2024
Revised: N/A
Molina approved: February 2024, January 2025
Chronic Obstructive Pulmonary Disease
Molina Healthcare has adopted the guideline for Global Strategy for Diagnosis, Management, and Prevention of COPD from the Global Initiative for Chronic Obstructive Lung Disease (GOLD).
The Clinical Practice Guideline may be accessed HERE.
Published: 2011
Revised: January 2026
Molina approved: February 2024, January 2025, February 2026
Dementia
Molina Healthcare has adopted the guideline for Dementia from the Alzheimer’s Association.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: May 2025
Depression
Molina Healthcare has adopted the guideline for VA/VOD Clinical Practice Guideline for the Management of Major Depressive Disorder from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: February 2022
Revised: N/A
Molina approved: February 2024, January 2025
Molina Healthcare has adopted the guideline for Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts from the American Psychological Association.
The Clinical Practice Guideline may be accessed HERE.
Published: February 2019
Revised: N/A
Molina approved: May 2025
Diabetes Treatment and Prevention
Molina Healthcare has adopted the guideline for Diabetes from the American Diabetes Association (ADA).
The Clinical Practice Guideline may be accessed HERE.
Published: January 2015
Revised: December 2025
Molina approved: February 2024, January 2025, February 2026
Elder Abuse
Molina Healthcare has adopted the guideline for Elder Abuse from the National Institute on Aging.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: August 2025
Heart Failure in Adults
Molina Healthcare has adopted the guideline for Management of Heart Failure from the American College of Cardiology (ACA).
The Clinical Practice Guideline may be accessed HERE.
Published: 2013
Revised: May 2022
Molina approved: February 2024, January 2025
You may also visit the web site below for more information.
American College of Cardiology HERE.
Hepatitis C
Molina Healthcare has adopted the clinical practice guideline for Hepatitis C from the Infectious Diseases Society of America.
The Clinical Practice Guideline may be accessed HERE.
Published: May 2023
Revised: N/A
Molina approved: May 2025
Homelessness – Special Health Care Needs
Molina Healthcare has adopted the guideline for Adapting Your General Recommendations for the Care of Homeless Patients from the National Health Care for the Homeless Council.
The Clinical Practice Guideline may be accessed HERE.
Published: 2010
Revised: N/A
Molina approved: February 2024, January 2025
You may also visit the web site below for more information.
National Health Care for Homeless Council HERE.
HIV/AIDS Treatment and Prevention
Molina Healthcare has adopted the guideline for Use of Antiretroviral Agents in Adults and Adolescents with HIV from the Department of Health and Human Services.
The Clinical Practice Guideline may be accessed HERE.
Published: April 2015
Revised: September 2024
Molina approved: September 2024, January 2025
Molina Healthcare has adopted the guideline for HIV/AIDS from the National Center for Biotechnology Information.
The Clinical Practice Guideline may be accessed HERE.
Published: January 2024
Revised: July 2024
Molina approved: September 2024, January 2025
You may also visit the web site below for more information.
Clinical Practice Guidelines for HIV/AIDS HERE.
Hypertension
Molina Healthcare has adopted the guideline for Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults from the American College of Cardiology.
The Clinical Practice Guideline may be accessed HERE.
Published: February 2014
Revised: May 2018
Molina approved: February 2024, January 2025
Incontinence
Molina Healthcare has adopted the clinical practice guidelines for Incontinence from the American Urological Association. Find them here:
Incontinence after Prostate Treatment
Published: 2019, July 2024, 2017
Revised: July 2024, July 2024, 2023
Molina approved: May 2025
Long-Term Services and Supports (LTSS)
Molina Healthcare has adopted the clinical practice guideline for Long-Term Services and Supports (LTSS) from Centers for Medicare and Medicaid Services (CMS).
The Clinical Practice Guideline may be accessed HERE.
Published: November 2020
Revised: N/A
Molina approved: May 2025
Osteoporosis
Molina Healthcare has adopted the guideline for Osteoporosis from American College of Physicians.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: May 2025
Parkinson’s Disease
Molina Healthcare has adopted the clinical practice guideline for Parkinson’s Disease from the American Physical Therapy Association.
The Clinical Practice Guideline may be accessed HERE.
Published: December 2021
Revised: August 2022
Molina approved: May 2025
Molina Healthcare has adopted the clinical practice guideline for Parkinson’s Disease from the American Family Physician.
The Clinical Practice Guideline may be accessed HERE.
Published: December 2020
Revised: N/A
Molina approved: May 2025
Perinatal & Postpartum Care
Molina Healthcare has adopted the guideline for Perinatal Care from the American College of Obstetricians and Gynecologists.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: February 2024, January 2025
Molina Healthcare has adopted the guideline for Management of Pregnancy from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: July 2023
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Postpartum Care from the American College of Obstetricians and Gynecologists.
The Clinical Practice Guideline may be accessed HERE.
Published: June 2016
Revised: May 2018
Molina approved: January 2025
Pressure Ulcers
Molina Healthcare has adopted the guideline for Pressure Ulcers from the National Pressure Injury Advisory Panel.
The Clinical Practice Guideline may be accessed HERE.
Published: 2009
Revised: November 2023
Molina approved: August 2025
Schizophrenia
Molina Healthcare has adopted the guideline for Schizophrenia from the American Psychiatric Association.
The Clinical Practice Guideline may be accessed HERE.
Published: 2021
Revised: N/A
Molina approved: February 2024, January 2025
Sickle Cell Disease
Molina Healthcare has adopted the guideline for Management of Sickle Cell Disease from the National Heart, Lung, and Blood Institute (NHLBI).
The Clinical Practice Guideline may be accessed HERE.
Published: December 2014
Revised: January 2020
Molina approved: February 2024, January 2025
You may also visit the websites below for additional information on Sickle Cell Disease:
American Society of Hematology - HERE.
Centers for Disease Control and Prevention - HERE.
Substance Use Disorder
Molina Healthcare has adopted the guideline for Alcohol Withdrawal Management from the American Society of Addiction Medicine (ASAM).
The Clinical Practice Guideline may be accessed HERE.
Published: January 2020
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Benzodiazepine Tapering from the American Society of Addiction Medicine (ASAM).
The Clinical Practice Guideline may be accessed HERE.
Published: March 2025
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Stimulant Use Disorder from the American Society of Addiction Medicine (ASAM).
The Clinical Practice Guideline may be accessed HERE.
Published: June 2024
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Management of Substance Use Disorder (SUD) from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: August 2021
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Pharmacological Treatment of Patients with Alcohol Use Disorder from The American Psychiatric Association.
The Clinical Practice Guideline may be accessed HERE.
Published: January 2018
Revised: N/A
Molina approved: May 2025
Molina Healthcare has adopted the guideline for Use of Medications in the Treatment of Addiction Involving Opioids from the American Society of Addiction Medicine (ASAM).
The Clinical Practice Guideline may be accessed HERE.
Published: June 2015
Revised: January 2020
Molina approved: February 2024, January 2025
Molina Healthcare has adopted the guideline for Prescribing Opioids for Chronic Pain from the Centers for Disease Control and Prevention.
The Clinical Practice Guideline may be accessed HERE.
Published: March 2016
Revised: November 2022
Molina approved: February 2024, January 2025
Suicide Prevention
Molina Healthcare has adopted the guideline for Assessment and Management of Patients at Risk for Suicide from the Department of Veterans Affairs & Department of Defense.
The Clinical Practice Guideline may be accessed HERE.
Published: May 2019
Revised: April 2024
Molina approved: February 2024, July 2024, January 2025
Trauma-Informed Primary Care
Molina Healthcare has adopted the guideline for Trauma Informed Care from American Psychological Association.
The Clinical Practice Guideline may be accessed HERE.
Published: N/A
Revised: N/A
Molina approved: February 2024, January 2025, October 2025
Weight Management
Molina Healthcare has adopted the guideline for Comprehensive Medical Care of Patients with Obesity from the American Association of Clinical Endocrinologists (AACE).
The Clinical Practice Guideline may be accessed HERE.
Published: July 2016
Revised: N/A
Molina approved: February 2024, January 2025
Molina Healthcare has adopted the guideline for Weight Management from
The American Academy of Pediatrics (AAP)
The American Psychological Association (APA)
The Journal of Obesity and Metabolic Syndrome
The Clinical Practice Guidelines may be accessed below:
Preventing Obesity and Eating Disorders in Adolescents
Published: September 2016
Revised: June 2022
Molina approved: January 2025
Published: March 2018
Revised: N/A
Molina approved: January 2025
Obesity in Adults: clinical practice guideline
Published: August 2020
Revised: N/A
Molina approved: January 2025
You may also visit the websites below for additional information on Weight Management:
American Academy of Pediatrics (AAP) - HERE.
National Institute of Health (NIH) - HERE.