CPCA Advances New Tools to Support FQHC Financial Sustainability
California’s Federally Qualified Health Centers (FQHCs) are navigating an increasingly complex reimbursement landscape, and CPCA is committed to ensuring members have the tools and clarity they need to sustain financial health.
To support this effort, CPCA is working on a supplemental payments resource and a policy guide. Designed to work in tandem, they will help clinics maximize current opportunities, while laying the foundation for a stronger, more equitable financing framework in the future.
Medi-Cal FQHC Reimbursement Mechanisms Supplemental to PPS resource
Now available for review and feedback here, the Medi-Cal FQHC Reimbursement Mechanisms Supplemental to PPS resource provides a high-level overview of supplemental reimbursement opportunities currently available to FQHCs beyond the Prospective Payment System (PPS). These include carve-outs for:
Pharmacy services
Enhanced care management and community supports under CalAIM
Dyadic care
ACEs and developmental screenings, and
Incentive-based arrangements such as pay-for-performance programs
The resource also addresses emerging payment streams like Certified Wellness Coaches and directed payments tied to equity and practice transformation. Together, these mechanisms represent critical revenue opportunities that clinics can leverage today to strengthen operations and expand services.
CPCA invites partners and members to review the resource and share feedback or questions by emailing eshipman@cpca.org. Your input will help ensure this tool remains accurate, actionable, and aligned with the realities of health center finance.
Medi-Cal FQHC Financing Policy Guide
At the same time, CPCA is collaborating closely with the Department of Health Care Services (DHCS) and the PPS Technical Advisory Committee (TAC) on the development of a Medi-Cal FQHC Financing Policy Guide. This guide will address longstanding policy gaps and ambiguities that impact rate-setting, change in scope processes, annual reconciliations, and the interaction between Medi-Cal policy and PPS rules.
Topics under review include cost assignment standards, treatment of pharmacy and laboratory costs, productivity benchmarks, telehealth coding, and reconciliation methodologies. By clarifying these areas, the guide aims to create a more transparent and predictable financial environment for FQHCs statewide.
CPCA will continue to keep members informed as this work progresses. For now, we encourage you to explore the supplemental payments resource and share your insights. Together, we can ensure California’s health centers remain financially resilient and equipped to deliver high-quality care to the communities that need it most.