California Medicaid Developing Capitated Payment Model For FQHCs

The California Department of Health Care Services (DHCS) is creating a capitated payment methodology for its federally qualified health centers (FQHCs). Under the proposed payment model, the Medi-Cal (California’s Medicaid program) managed care plans will pay the FQHCs an actuarially sound, capitated rate for each Medicaid beneficiary served. Each FQHC will be responsible for providing all services for the member that falls under its scope of services, including physical health services, as well as behavioral health services, obstetrics, and pharmacy if provided.

The Medi-Cal managed care organizations (MCOs) already include FQHCs in their provider organization networks. For . . .