Skilled Nursing Facility Value Strategy
DHCS is developing a comprehensive value strategy for Medi-Cal Skilled Nursing Facility (SNF) services to inform the reauthorization of the Medi-Cal Long-Term Care (LTC) Reimbursement Act (Welfare & Institutions Code (WIC) 14126, et seq.) for dates of service on or after January 1, 2027. The Medi-Cal Long-Term Care Reimbursement Act governs the overall Medi-Cal financing framework for Freestanding SNFs, and its upcoming renewal provides a historic opportunity to continue building on the CalAIM LTC Carve-in and the AB 186 Nursing Facility Financing Reform programs. The SNF Value Strategy will include a landscape analysis of payment methodologies utilized by Medi-Cal, Medicare, and other payers and a Multi-Year Roadmap to drive system transformation and integration over a five-year horizon. DHCS will engage with stakeholders throughout the development of the SNF Value Strategy.
DHCS has proposed the following guiding principles for the SNF Value Strategy. These guiding principles may be subject to further revision and refinement through the stakeholder engagement process.
- Whole-Person Care & Care Coordination: Coordinating and integrating care through the Medi-Cal managed care delivery system to provide whole-person care to members with institutional level-of-care needs and support the development of comprehensive Managed Long-Term Services and Supports (MLTSS).
- Quality Accountability and Incentives: Holding SNFs accountable for providing quality patient care and incentivizing quality improvement in alignment with and furtherance of DHCS’s Comprehensive Quality Strategy.
- Care Transitions and Financial Alignment: Creating financial incentives for the delivery of care in the right setting, including appropriate transitions from hospital settings to SNFs and from SNFs to HCBS settings.
- Workforce Investment and Accountability: Emphasizing the critical role of workforce as a key driver of quality patient care, and holding facilities accountable for using Medi-Cal funds to provide fair compensation and benefits to workers.
- Financial Sustainability & Efficiency: Provisioning services economically and efficiently to support the financial sustainability and affordability of California’s health care system.
- Access & System Integrity: Supporting adequate access to skilled nursing facility care, including in rural areas, and removing perverse incentives in resident admissions, transfers, and discharges.
DHCS has selected Mathematica and Myers and Stauffer as consultants to support this work.
Stakeholder Engagement
Call for Nominations
DHCS is issuing a call for nominations for a new workgroup which will be charged with advising DHCS on the development and implementation of its new SNF Value Strategy.
Who Should Apply to be Part of the SNF Value Strategy Stakeholder Workgroup?
This call for nominations is open to everyone with a demonstrated knowledge of Medi-Cal long-term care and nursing facility operations and payment. We are seeking a diverse group of interested parties, such as:
- Medi-Cal members who currently or have previously resided in a nursing facility, caregivers of Medi-Cal members residing in nursing facilities, and consumer advocacy organizations
- Nursing facility operators and administrators
- Representatives of organized labor and front-line care staff working in nursing facilities
- Long-term care clinicians and policy experts
- Representatives of Medi-Cal managed care plans
- Cross-system stakeholders such as representatives of hospitals, HCBS providers, or behavioral health systems or providers
- Nominations will be accepted for individual subject matter experts and organizational representatives. Self-nominations are also encouraged. We anticipate that there will be between 20-25 members of the SNF Value Strategy Stakeholder Workgroup.
How Will SNF Value Strategy Stakeholder Workgroup Members be Selected?
DHCS will select a diverse group of stakeholders that will represent specific groups and expertise. DHCS will consider inclusion of a range of both deep policy expertise and lived experience, as well as representation from people receiving services and their caregivers. DHCS will also consider geographic representation throughout California where feasible.
What is Involved?
Members of the SNF Value Strategy Stakeholder Workgroup should plan to attend monthly meetings beginning in January 2026. DHCS anticipates that the group will continue to meet through the implementation period for the value strategy. Most meetings will be held virtually, but there may be some regional in-person gatherings.
How to Apply
To nominate yourself or a colleague to the SNF Value Strategy Stakeholder Workgroup, please complete the SNF Value Strategy Stakeholder Workgroup Nomination form, which includes:
- Nominee information
- Nominator information (if different from nominee)
- Areas of nominee expertise/interest
- Brief description of the nominee’s interest, knowledge, experience, and how they would contribute to the Workgroup
Submission Deadline
All nominations must be submitted on the SNF Value Strategy Stakeholder Workgroup Nomination form by 8pm Pacific Time on December 5, 2025. If you have questions or any technical difficulties with the nomination form, please contact SNFValueStrategy@dhcs.ca.gov.
Related Work
LTC Reimbursement Rates
Current LTC reimbursement rates and policy information is available on the Long Term Care Reimbursement webpage.
CalAIM LTC Carve-In
As part of the CalAIM initiative, DHCS standardized and integrated coverage of LTC services by Managed Care Plans statewide effective January 1, 2023 and January 1, 2024. Visit the CalAIM LTC Carve-in webpage for more information.
Nursing Facility Financing Reform (AB 186)
DHCS implemented several new Nursing Facility Financing programs pursuant to AB 186 between 2022 and 2024 including the Workforce & Quality Incentive Program (WQIP), Workforce Standards Program (WSP), and Accountability Sanctions Program (ASP). The future of these programs, as well as lessons learned, will be considered as part of the SNF Value Strategy. To access historical materials related to this work, visit the Nursing Facility Financing Reform (AB 186) webpage.
HCBS Gap Analysis and Multi-Year Roadmap of Medi-Cal HCBS
To support California's transition to a statewide, fully integrated long-term services and supports (LTSS) system, DHCS commissioned a gap analysis and multi-year roadmap of Medi-Cal home and community-based services (HCBS) and managed LTSS programs. To learn more about the multi-year roadmap, visit the HCBS Integration webpage.
Stay Connected
To receive updates on the SNF Value Strategy and relate programs, sign up for the e-mail distribution list.
Questions
To submit questions about the SNF Value Strategy, send an email to: SNFValueStrategy@dhcs.ca.gov., or by mail to the following address:
Department of Health Care Services
Attention: Chief, LTSS Financing Branch
Fee-For-Service Rates Development Division
1501 Capitol Avenue, MS 4600
P.O. Box 997417
Sacramento, CA 95899-7417
