Strategy & Tactics in California

CHCF Brief: Assisted Living as Housing Solution for Californians with Behavioral Health Needs

California Health Care Foundation published a new policy brief on April 17, 2026 outlining pathways to expand assisted living facility access for Californians with serious behavioral health needs. The brief offers a referral pathway for FQHC ECM programs and behavioral health integration teams navigating complex-care patient housing — especially relevant as the CalAIM 1115 waiver expires December 2026. FQHCs running ECM with Complex Care Management and Housing Supports should map these resources to their care coordination workflows.

CHCF Publishes 'Six Bold Ideas for the Future of Medi-Cal' — Including Unified Primary Care Payment Model

CHCF selected 6 transformative proposals from 132 submissions for the Future of Medi-Cal Commission: (1) unified primary care payment across Medi-Cal/CalPERS/Covered CA, (2) IHSS managed care integration, (3) Covered California expansion for coverage continuity, (4) 'Any Card, Any Provider' network unification, (5) AI-first Health Data Utility, and (6) unified financing model. The unified payment proposal could replace FQHC PPS with a standardized multipayer model.

CHCF Hosting April 16 Policy Briefing on AI Implementation in Safety-Net Health Centers

The California Health Care Foundation is hosting a policy briefing on April 16 examining AI adoption challenges and opportunities specific to safety-net providers including FQHCs. Topics include ambient documentation ROI, equity considerations in AI deployment, and regulatory frameworks. Features presentations from FQHC leaders who have implemented AI tools. Free registration open.

CHCF Examines How AI Can Responsibly Expand Language Access for LEP Patients in Safety-Net Settings

The California Health Care Foundation published a brief examining how AI-powered interpretation and translation tools could reduce the cost of language services while expanding access for limited English proficiency (LEP) patients. FQHCs serve heavily LEP populations across Spanish, Cantonese, Vietnamese, Tagalog and other languages. The brief examines responsible implementation — critical for FQHCs balancing CLAS Standards compliance with budget constraints.

OCHIN Brief: Critical Medicare Readiness Gaps at California Community Health Centers

An OCHIN brief identifies critical Medicare readiness gaps at California community health centers as the population they serve ages. Many FQHCs lack billing infrastructure, credentialing processes, and clinical workflows optimized for Medicare patients. As Medi-Cal populations age into Medicare and FQHCs diversify payer mix away from Medi-Cal dependency, Medicare readiness becomes a financial survival strategy.

Strategy: Integrating ECM Revenue into Ryan White Programs — A Sustainability Playbook for FQHCs

FQHCs with Ryan White funding can layer CalAIM Enhanced Care Management (ECM) revenue on top of existing HIV/AIDS grants — but with a critical exclusion: members enrolled in the HIV/AIDS HCBS Waiver (MCWP) cannot simultaneously receive ECM. The playbook: (1) Identify Ryan White clients who are Medi-Cal eligible but NOT on the MCWP waiver — they can be referred to ECM. (2) Use ECM for HIV+ patients with complex social needs (housing instability, reentry, SUD). (3) Build CHW/care coordinator capacity funded by ECM PMPM to supplement Ryan White case management. (4) Ryan White remains payer of last resort — ECM captures Medi-Cal revenue first. Golden Valley Health Centers (Merced County) is modeling this with ECM + HIV focus.

Strategy: Build ECM Caseload Now Before Dec 2026 Waiver Expiration — Window Is Closing

With CalAIM's 1115 waiver expiring Dec 2026 and a hostile federal environment for SDOH-focused Medicaid programs, FQHCs must maximize ECM enrollment now. Revenue strategy: (1) Screen every Medi-Cal patient for ECM eligibility (7 populations of focus including HIV+, SMI, SUD, homelessness, justice-involved). (2) Layer ECM on grant-funded programs — Ryan White clients on Medi-Cal (not MCWP waiver) can be ECM-enrolled. (3) Cross-train CHWs for both ECM care coordination and Ryan White case management. (4) Build data infrastructure showing ECM outcomes (reduced ED visits, improved engagement) to justify renewal. (5) Join CPCA and NACHC advocacy for waiver renewal with full ECM/Community Supports authority.

Strategy: Maintaining Sliding Fee Scale Access When PPS Rates Are Cut

When PPS rates drop for undocumented patient services (Oct 2026), FQHCs must decide: absorb the loss and maintain access, or restrict services. Tactics include maximizing 340B drug pricing savings, renegotiating managed care contracts to cross-subsidize, applying for HRSA New Access Points or expanded scope grants, and partnering with county indigent care programs for supplemental funding.

Strategy: CHW Outreach to Undocumented Communities Post-Enrollment Freeze

With new Medi-Cal enrollment frozen for undocumented adults 26-49, FQHCs must proactively communicate that doors remain open. Effective tactics: deploy bilingual CHWs to community events, partner with immigrant-serving organizations (churches, legal aid, consulates), use promotora networks, and emphasize that FQHCs never report immigration status. Focus messaging on sliding fee scale, no-copay visits, and FQHC statutory protections.

Strategy: Revenue Diversification — 340B, Grant Stacking, and MCO Contract Negotiation

With PPS revenue under threat, FQHC leaders should diversify aggressively. Key levers: (1) Maximize 340B drug pricing savings — contract pharmacy arrangements can generate $500K-$2M annually. (2) Stack grants — HRSA Quality Improvement, SAMHSA CCBHC, state HCAI workforce grants. (3) Renegotiate MCO contracts — use CalAIM Community Supports as new revenue streams. (4) Bill CHW encounters under new Medi-Cal codes. (5) Implement co-visit billing systematically.

Strategy: Communicating to Undocumented Patients That FQHC Doors Stay Open

Fear of immigration enforcement is driving undocumented patients away from healthcare — even from FQHCs. Critical communication tactics: (1) Post multilingual signage stating FQHC does not collect or share immigration status. (2) Train all front desk staff to reassure patients verbally. (3) Partner with immigrant rights organizations for trusted referrals. (4) Use community radio and social media in Spanish, Vietnamese, Mandarin. (5) Remind patients that sliding fee scale means care at any price point. (6) Coordinate with legal aid for 'Know Your Rights' sessions on-site.

California FQHC Alternative Payment Model Goes Live — Global Payments Replace Fee-for-Service

California's FQHC Alternative Payment Model (APM) launched January 1, 2026, moving participating FQHCs from fee-for-service to prospective global payments with care coordination incentives. The APM provides revenue stability by decoupling payment from visit volume — critical as Medicaid cuts reduce patient panels. However, implementation requires sophisticated cost accounting, care delivery restructuring, and population health infrastructure. DHCS is running an annual enrollment cycle; FQHCs can opt in during open periods.