Medi-Cal Long-Term Care Reimbursement
The California Department of Health Care Services (DHCS) Fee For Service Rates Development Division establishes Medi-Cal reimbursement rates for the following long-term care (LTC) facilities:
- Freestanding Skilled Nursing Level B and Adult Subacute Rates and Policy.
- Freestanding Pediatric Subacute (FS/PSA) Rates and Policy
- Distinct Part Pediatric Subacute (DP/PSA) Rates and Policy
- Distinct Part Skilled Nursing Facilities (DP/NF-B) Rates and Policy
- Distinct Part Adult Subacute Units (DP/SA) Rates and Policy
- Intermediate Care Facilities – Developmentally Disabled – Habilitative – Nursing (ICF/DD-H-N) Rates and Policy
- Nursing Facilities – Level A (NF-A) Rates and Policy
- Rural Swing Beds (RSB) Rates and Policy
- Transitional Inpatient Care Administrative Days – Level 1 (Admin Day) Rates and Policy
- Hospice Care Rates and Policy
The Medi-Cal LTC reimbursement rates are established under the authority of Title XIX of the federal Social Security Act. The specific methodologies are described in the California State Plan, Attachment 4.19-D.
Workforce Standards Program
The Workforce Standards Program (WSP) for FS/NF-B and FS/SA facilities is now live. Please visit the WSP website for more information.
CalAIM Long-Term Care Carve-In Transition
Under CalAIM, Medi-Cal managed care plans (MCPs) will cover and coordinate Medi-Cal institutional LTC in all counties in 2023 in a phased approach by facility type.
Detailed information about the transition can be found on the CalAIM Long Term Care Carve-In Transition webpage.
Please see the following All Plan Letters for requirements applying to MCPs:
- APL 24-009, Skilled Nursing Facilities — Long Term Care Benefit Standardization and Transition of Members to Managed Care
- APL 24-010, Subacute Care Facilities — Long Term Care Benefit Standardization and Transition of Members to Managed Care
- APL 24-011 ICF/DD – LTC Benefit Standardization and Transition of Members to Managed Care
Contact Us
Please send questions regarding FS/NF-B and FS/SA rates to AB1629@dhcs.ca.gov.
Please send questions regarding other LTC rates to LTCReimbursement@dhcs.ca.gov.