California To Seek Approval For Voluntary Medicaid Capitated Payment Model For FQHCs

The California Department of Health Care Services (DHCS) is developing a voluntary Medicaid capitated payment model for federally qualified health centers (FQHCs). The new alternative payment methodology (APM) would mean that the participating FQHCs would receive a capitated per-member per-month (PMPM) payment for Medicaid-only managed care members rather than through the current reimbursement model—a volume-based prospective payment system (PPS). Participating FQHCs would continue to receive PPS for non-managed care Medicaid beneficiaries and dual eligible populations (eligible for both Medicare and Medicaid). DHCS has been working on this concept since 2017 with plans to now . . .