MedicaidReimbursementMedium impact
24-531 New Federally Qualified Health Centers Alternative Payment Methodology Pilot Begins July 1, 2024
Health Net·CA · Family Medicine, Internal Medicine, General Practice +1 more·Prior Authorization
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
Effective July 1, 2024, three California FQHCs (County of Santa Clara, Harbor Community Health Centers, and Winters Healthcare Foundation) moved from traditional Prospective Payment System to a new per-member-per-month reimbursement model for Medi-Cal managed care members. Billing teams must understand that contracted FQHCs receive PMPM payments instead of fee-for-service billing, while non-contracted FQHCs still require PPS rate payments.
Action Required
Immediately: Billing teams must verify FQHC contract status before processing payments. For members receiving services at contracted APM pilot FQHCs (County of Santa Clara, Harbor Community Health Centers, Winters Healthcare Foundation), do not make additional payments as costs are covered by PMPM rates. For non-contracted FQHCs, continue paying PPS rates. Update billing workflows to check DHCS website for current participating FQHCs and rate updates.