MedicaidReimbursementMedium impact
07-02-2026 Skilled Nursing Facility Workforce Quality Incentive Program – APL 26-006 IE LA SAC SD
Molina Healthcare·CA · Geriatrics, Palliative Care·Quality Measures
Effective date
Jan 1, 2023
We identified it
Jul 7, 2026
Summary
Molina Healthcare of California is implementing the Skilled Nursing Facility Workforce Quality Incentive Program (WQIP) under APL 26-006, which provides performance-based supplemental payments to eligible SNF providers for Program Years 2023-2025 based on qualifying bed days and performance metrics. Billing teams must ensure accurate and timely claim submission to capture all qualifying bed days, and must monitor compliance as citations can reduce or eliminate WQIP payments. Molina must issue payments within 45 calendar days of receiving payment exhibits from DHCS or within 30 calendar days of receiving a Clean Claim, whichever is later.
Action Required
REQUIREMENTS:
- Immediately: SNF billing teams must ensure all claims for Freestanding SNF Level-B and Adult Freestanding Subacute Facilities Level-B services are submitted accurately and timely to capture qualifying bed days for WQIP payment consideration.
- Ongoing: Verify that qualifying bed days meet program requirements (Medi-Cal primary payer, within Network Provider Agreement, exclude Medicare coverage, hospice services, and out-of-network services).
- Ongoing: Monitor compliance and quality performance activities, as Class A citations result in 40% payment reduction and Class AA citations result in full ineligibility for the program year.
- Ongoing: Review bed day data reports from Molina Healthcare; report any discrepancies through established channels or LTSS liaisons for reconciliation.
- By 45 calendar days of DHCS payment exhibit receipt or 30 calendar days of Clean Claim receipt (whichever is later): Molina must process and issue WQIP payments to eligible SNF providers.
- Consequences: Inaccurate or late claim submission will result in loss of qualifying bed days and WQIP supplemental payments; compliance citations will reduce or eliminate payments; payments not issued within required timelines may accrue interest.