Freestanding Skilled Nursing Facilities and Subacute Units

Medi-Cal reimbursement rates for Freestanding Skilled Nursing Facilities Level-B (FS/NF-B) and Adult Freestanding Subacute Facilities Level-B (FSSA/NF-B) are updated each calendar year (CY) using a cost-based facility-specific methodology pursuant to Supplement 4 of Attachment 4.19-D of the California Medicaid State Plan.

Workforce Standards Program

Pursuant to Assembly Bill (AB) 186 (Chapter 42, Statutes of 2022) and State Plan Amendment (SPA) 24-0004, DHCS has established the Workforce Standards Program (WSP) beginning for CY 2024. Facilities that participate in the WSP will receive the enhanced per diem rate including the Workforce Rate Adjustment. Facilities that do not participate in the WSP will receive the basic per diem rate. 

The CY 2024 and CY 2025 Rate Studies display both each facility's basic and enhanced per diem. DHCS is processing WSP opt-ins on a batch basis and updating CY 2024 and CY 2025 Rates on File to reflect the facility's participation in WSP. DHCS published the sixth batch of updated Rates on File reflecting WSP opt-ins in May 2025 and further batches will be published soon. Facilities continue to receive the CY 2023 Rates on File until updated CY 2024 and CY 2025 Rates on File are published. 

CY 2025 Rates

CY 2025 Rates Studies

• CY 2025 FS/SNF-B Rate Study
• CY 2025 FSSA Rate Study

CY 2025 Rates Policy Letters

• LTC Rates Policy Letter 25-001: FS/NF CY 2025 Rates

CY 2025 Published Rates on File

• CY 2025 FS/SNF-B Rates and FS/SA on File (updated 05/16/2025)

CY 2024 Rates

CY 2024 Rates Studies

• CY 2024 FS/SNF-B Rate Study
• CY 2024 FS/SNF-B Rate Recomputations
  
• CY 2024 FSSA Rate Study

The CY 2024 rate studies calculate both the basic and enhanced per diem rates for each facility. Facilities that participate in the WSP will receive the enhanced per diem rate including the Workforce Rate Adjustment. Facilities that do not participate in the WSP will receive the basic per diem rate. 

CY 2024 Rates Policy Letters

• LTC Rates Policy Letter 24-001: FS/NF CY 2024 Rates & WSP
  
• LTC Rates Policy Letter 24-003: WSP Deadline Extension
  

CY 2024 Published Rates on File

• CY 2024 FS/SNF-B and FS/SA Rates on File (updated 05/16/2025)
  

CY 2023 Rates

CY 2023 Rate Studies

• CY 2023 FS/SNF-B Rate Study
• CY 2023 FS/SA Rate Study
• Fair Rental Value System

CY 2023 Rates Policy Letters

• LTC Rates Policy Letter 23-001: FS/NF CY 2023 Rates
• LTC Rates Policy Letter 23-002: Change in Ownership Rates

CY 2023 Published Rates on File

• CY 2023 FS/SNF-B Rates on File (updated 3/14/2025)
  
• CY 2023 FS/SA Rates on File (updated 3/14/2025)

Managed Care Plan Carve-In

Under CalAIM, Medi-Cal managed care plans (MCPs) will cover and coordinate Medi-Cal institutional Long-Term Care (LTC) in all counties in 2023 in a phased approach by facility type. Please see the CalAIM Long-Term Care Carve-In Transition website for additional information.  

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

Medi-Cal COVID-19 PHE Audits

Assembly Bill (AB) 81 (Chapter 13, Statutes of 2020) and Welfare and Institutions Code (WIC) section 14126.032 require DHCS to audit Freestanding Skilled Nursing Facilities Level-B (FS/NF-B) and Adult Freestanding Subacute Facilities (FSSA) costs and revenues that are associated with the COVID-19 Public Health Emergency (PHE) to determine whether a facility has adequately used increased Medi-Cal payments associated with the COVID-19 PHE to support the delivery of patient care, as defined in Section 14126.032(a).

Detailed information about the program, audit process, and reporting schedules can be found on the COVID-19 PHE Audits website.