About Finance & Reimbursement
Vulnerable Californians who rely on the care provided by California hospitals are at risk. Driven by skyrocketing costs for labor, pharmaceuticals, regulatory mandates, and more, 53% of all hospitals statewide lose money every day to deliver patient care.
That isn’t sustainable. And California is already seeing the frightening result: rural health care services being cut to the bone, severe behavioral health care needs not being met, and more.
Action Needed for Prescribers: Ensure Enrollment as Medi-Cal FFS Provider
What’s happening: Beginning on June 26, claims and prior authorizations will not be processed by Medi-Cal Rx if the prescribing health care provider is not enrolled in Medi-Cal fee-for-service (FFS) with a Type 1 National Provider Identifier (NPI).
CHA DataSuite Releases Analysis of FFY 2027 Wage Index and Occupational Mix Data
What’s happening: CHA DataSuite has issued a hospital-specific impact analysis of Medicare’s revised public use files (PUFs) data for the development of the federal fiscal year (FFY) 2027 hospital wage index and occupational mix data.
CMS Issues Updated Guidance on Medicaid State-Directed Payments
What’s happening: On Feb. 2, the Centers for Medicare & Medicaid Services (CMS) issued a letter providing guidance on Section 71116 of the One Big Beautiful Bill Act, which eventually limits the total managed care payment rate received by hospitals to Medicare levels after a temporary grandfathering period. This letter supersedes the guidance CMS released on Sept. 9, 2025.
Federal Spending Deal Includes Key Wins for Hospital Care
Hospitals and health systems are getting some financial relief and operational predictability, thanks to a bipartisan health care spending bill signed by President Trump earlier this week.
Inpatient Post-Acute Care Transfer Policy Analysis Shows Impact on FFS Payments
What’s happening: DataSuite has issued hospital-specific analyses of the inpatient post-acute care transfer (PACT) adjustment policy. The analysis shows the estimated impact on Medicare inpatient fee-for-service payments, and corresponding Medicare severity diagnosis-related group (MS-DRG) volumes from the inpatient prospective payment system (IPPS) during federal fiscal years 2021-26.
Prop 35 Advisory Committee Presents Revised 2025-26 Spending Plan at January Meeting
What’s happening: At its Jan. 14 meeting, the Proposition 35 Protect Access to Health Care Act Stakeholder Advisory Committee was presented a revised spending plan for calendar years 2025 and 2026. The spending plan reflects investments supported by managed care organization (MCO) tax proceeds generated from taxes imposed on Medi-Cal managed care plans.
CHA’s ‘Hospital 101’ Briefing for State Legislators and Staff Offers Overview of Hospital Landscape
What’s happening: On Jan. 13, CHA hosted a Hospital 101 briefing to educate more than 60 legislators and legislative staff on hospitals’ role in the health care ecosystem ahead of the new legislative session.
CHA Publishes New Advocacy Materials on Priority Issues for 2026
What’s happening: CHA’s board has approved three advocacy priorities for California hospitals in 2026: Office of Health Care Affordability (OHCA), Securing Hospitals, and Ballot Initiatives. New and updated advocacy materials for two of these priority issues are available on CHA’s website.
Download Private Hospital-Directed Payment Encounter Files by Feb. 5
What’s happening: On Dec. 26, the Department of Health Care Services (DHCS) uploaded three new hospital-directed payment encounter files, available via the Secure File Transfer Protocol (SFTP) site. The SFTP site is not intended for long-term storage, so files will be deleted Feb. 5.
2026-27 State Budget to be Released Tomorrow
What’s happening: Governor Gavin Newsom will release his proposed budget for 2026-27 tomorrow, kicking off the state budget process and legislative budget hearings that will continue until the budget is finalized this summer.