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.
CMS Awards California $234M in Rural Transformation Grant Funding
What’s happening: On Dec. 29, the Centers for Medicare & Medicaid Services (CMS) released the much-anticipated Rural Health Transformation Program (RHTP) award announcements. While all 50 states were awarded RHTP funds, California earned an award of $233.6 million in the first year, the third-highest dollar amount award of any state.
DHCS Granted 60-Day Extension to Revise Hospital Fee Program 9 Application
What’s happening: The Department of Health Care Services (DHCS) has until March 13 to submit a revised 2025 Hospital Quality Assurance Fee Program application to the Centers for Medicare & Medicaid Services (CMS), following questions CMS raised about the program’s size.
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
Summaries Available for CY 2026 Home Health, End-Stage Renal Disease Payment Final Rules
What’s happening: Summaries of the calendar year (CY) 2026 home health prospective payment system (PPS) and end-stage renal disease (ESRD) PPS final rules are available for CHA members.
Summary of CY 2026 PFS Final Rule Includes Impact Analysis for 100+ Medicare Specialties
What’s happening: A summary of the calendar year (CY) 2026 physician fee schedule (PFS) final rule is available for CHA members.
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.