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Collection · 9 articles
Community health centers are navigating the largest Medicaid changes in a generation — the December 31, 2026 triple cliff (Community Health Center Fund, CalAIM waiver, MCO tax), the July 1 UIS-PPS and dental changes, and the SB 525 wage floor. This collection tracks what changes, when, and how to model the revenue impact.
Policy & Strategy
Three authorities expire the night of December 31, 2026 — the ~$4.6B/yr Community Health Center Fund, California's CalAIM 1115 waiver, and the ~$4.5B/yr Medi-Cal MCO tax — and ACO REACH sunsets the same midnight. The canonical explainer: what each cliff is, what's already de-risked, what survives regardless, and a role-by-role playbook for the 204 days left.
Policy & Strategy
Newsom signed the 2026-27 budget on June 29. SB 525 and Section 504 still matter now, while UIS/PPS clinic-payment cuts, UIS dental benefit cuts, and Prop 56 dental supplemental payment cuts are delayed to July 1, 2027.
Policy & Strategy
The Santa Cruz ~$2.3M disclosure is still the template, but the signed budget turns the UIS/PPS cut from a July 2026 shock into a July 1, 2027 planning window. A CFO worksheet for using the delay well.
Policy & Strategy
California's Medi-Cal MCO tax funds the primary-care rate floor that flows into FQHC reimbursement. Read this as the pre-budget setup; later budget negotiations now drive the operating interpretation.
Policy & Strategy
FQHCs can bill APCM (G0556/57/58) as monthly, no-downside-risk Medicare revenue. CY2026 adds BHI add-ons G0568/69/70 and sunsets G0512/G0071. Sourced to CMS, AAFP & NACHC.
Policy Analysis
Newsom's May 14, 2026 May Revision kept every January Medi-Cal cut and stacked four new ones on top: forced FFS transition for ~2M undocumented adults, state-imposed work requirements, asset limit reinstated at $2K/$3K, Prop 56 supplemental payments eliminated. Plus the premium increase to $50/month. Full side-by-side comparison, FQHC impact by service line, and timeline through July 2027. Every claim primary-sourced.
Policy Analysis
California's CalAIM 1115 waiver expires December 31, 2026. CMS approval now expected late December — at the cliff edge. ~$1.2B/yr in ECM and Community Supports funding hangs on the outcome. Six federal headwinds, seven structural tailwinds, and four scenarios FQHC CFOs should be modeling. Most likely outcome: narrowed renewal — plan FY27 baseline accordingly.
Strategy
LA County Measure ER passed and the half-cent sales tax takes effect October 1, 2026. The question for LA-area FQHCs is no longer pass/fail; it is bridge timing, allocation, reporting, and how to use the new safety-net backfill well.
Career Resources
A February 2026 workforce snapshot on Medi-Cal funding risk for community health workers. The signed June 2026 budget later delayed major clinic-payment and dental cuts to July 1, 2027.
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