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.
Medicaid State-Directed Payments Help Ensure Patient Access to Care
About State-Directed Payments (SDPs) SDPs are additional payments made to health care providers to support Medicaid quality and access goals. The Centers for Medicare & Medicaid Services (CMS) reviews and approves SDPs for each 12-month rating period. Payments to providers are made via managed care organizations (MCOs) and are based on utilization of Medicaid services....
Medicaid Provider Taxes Protect Californians’ Access to Care
Medicaid provider taxes are a cornerstone of the Medicaid financing structure. Without federal revenue generated from these taxes, reimbursement for care provided to patients covered by Medicaid would be woefully insufficient and health care access would be at grave risk. For many hospitals, losing this revenue would mean closure of service lines; for others, it...
Medicare IRF Review Choice Demonstration – What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) is expanding the Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facility (IRF) Services to California, forcing all California IRFs to choose between either 100% pre-claim review or 100% post-payment review. That decision must be made by April 14.
Issue Brief: Time Is Running Short to Save Hospitals, Preserve Access to Health Care
Medicare and Medi-Cal underfunding have put the health care system on the precipice.
Key Messages: California’s Health Care System Is on Life Support
The risk of losing access to critical health care services for Californians has never been greater.
Infographic: Financial Instability
Federal Funding Will Bolster Medi-Cal Reimbursement for Inpatient Psychiatric Care
What’s happening: On Dec. 16, California was approved for the large BH-CONNECT behavioral health demonstration project, which is estimated to bring $5 billion of new federal Medicaid dollars for California over the next five years.
Managed Care Organization Tax
On Nov. 5, California voters overwhelmingly approved Proposition (Prop) 35, making an existing tax on managed care organizations (MCO) permanent under state law — and directing most of the revenues toward expanding access to care for Medi-Cal patients through improved provider reimbursement. Now, work by the state, hospitals, and others to determine how these funds...
TEAM Bundled Payment Final Rule Webinar – Participant Information
Over 100 California hospitals were selected to participate in the finalized Transforming Episode Accountability Model (TEAM). Additionally, current participants in other Medicare bundled payment models can opt into TEAM which begins in January of 2026.
Dual Eligible Medi-Cal Managed Care Enrollment — Participant Information
CalAIM is standardizing Medi-Cal coverage for people enrolled in both Medi-Cal and Medicare with changes for many Californians starting next year. On January 1, 2023, those enrolled in Medicare and Medi-Cal, who currently receive their Medi-Cal benefits through traditional fee-for-service, will have their Medi-Cal benefits transitioned to Medi-Cal managed care statewide, which could mean changes...