MedicaidReimbursementMedium impact
24-529 New Federally Qualified Health Centers Alternative Payment Methodology Pilot Begins July 1, 2024
Health Net·CA · Family Medicine, Internal Medicine, Pediatrics +1 more·Prior Authorization
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
Three Federally Qualified Health Centers in California are transitioning from traditional fee-for-service billing to a new capitated payment model effective July 1, 2024. This affects how physician groups handle payments when their members receive services at these specific FQHCs.
Action Required
Immediately: Billing team must identify if practice has contracted physician groups with members who receive services at County of Santa Clara, Harbor Community Health Centers, or Winters Healthcare Foundation FQHCs. Update billing workflows to ensure no additional payments are made to contracted FQHCs (cost included in capitated rate), but continue paying PPS rates for non-contracted FQHCs. Monitor DHCS website for updated participating FQHCs and rate changes.