About Medi-Cal
More than 15 million Californians rely on Medi-Cal, the state’s version of the federal program known as Medicaid, for health insurance. The program acts as California’s health care coverage safety net, with those on Medi-Cal often living in communities with a lack of adequate health care providers. Without significant investments to support providers that deliver health care to California’s most vulnerable, millions living in rural and underserved areas are in jeopardy.
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).
Insurance Companies Play Blame Game, But They Have Much to Answer For
Late last month, the chief executives of some of the nation’s largest insurance companies — UnitedHealth, CVS, Cigna, Elevance, and the California Blues — trekked to Capitol Hill for a day of hearings where federal lawmakers probed one of the most pressing issues of the day: health care affordability.
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.
DHCS to Host Webinar on Implementation of One Big Beautiful Bill Act
What’s happening: On Feb. 5 at 11 a.m. (PT), the Department of Health Care Services will host an “all-comer” webinar to walk through its implementation plan for House Resolution (H.R.) 1, the One Big Beautiful Bill Act, which will make sweeping changes to Medicaid.
CHA Joins ‘Future of Medi-Cal’ Advisory Group
What’s happening: CHA’s Adam Dorsey, group vice president, financial policy, has been named as one of 50 new advisory group members for the state’s Future of Medi-Cal Commission.
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.
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.