Prepared for Community Health Centers of America
Where CHCA's 2026 dollars are at stake, and which ones are recoverable
A pre-read for our first conversation. One page, three pressures, one number to replace with your own.
More than a third of the Alliance incentive rides on admissions and discharges
Central California Alliance for Health, 2026 Care-Based Incentive, 100 points total. Applies to your Merced and Mariposa sites.
53 quality of care
11 access
36 admissions & transitions
36 pointsPost-discharge visit within 14 days (10.5), plan all-cause readmissions (10.5), preventable ED visits (8), ambulatory-care-sensitive admissions (7).
53 pointsScreenings, immunizations, well-child visits, blood pressure and diabetes control.
11 pointsInitial health appointment, ACEs and developmental screening, fluoride varnish.
These 36 points are won by knowing, within days, which of your patients were admitted or discharged, and getting them seen. With pulmonary and critical care, SNF coverage and a 24/7 provider center, CHCA is built for this. The missing piece is usually the data that tells the clinic who to call.
The July 2027 PPS cut, sized for CHCA
Starting July 1, 2027, delayed a year by this summer's state budget, services to Medi-Cal members with unsatisfactory immigration status (UIS) will be paid at fee-schedule rates instead of PPS. That leaves about nine months to prepare.
Replace the placeholders below with your figures.
Estimated annual revenue no longer paid at PPS
$1,140,000
6,000 UIS visits × $190 difference per visit
Placeholder inputs, not CHCA data. UIS adult dental visits drop to zero reimbursement rather than fee-schedule rates, so the figure understates the impact for dental. The point is the shape: every percentage point of UIS share is real money, and it compounds with the move of these members to fee-for-service Medi-Cal in January 2027, which also removes them from plan-attributed incentive denominators.
Why the plans will push harder on quality this year
Plans are being fined
DHCS sanctioned 20 of 24 Medi-Cal plans for missing minimum quality levels. Fluoride for children, well-care visits and cervical screening drove about 82% of the penalties. CHCA runs pediatrics and co-located dental.
Fines are counted by county
DHCS scores each plan per county, per measure. In a small county like Mariposa, one network's panel can move the plan's rate, which makes that network worth courting.
Membership is shrinking
Alliance Medi-Cal membership in Merced fell from about 148,900 to 146,100 in five months of 2025, before the 2026 enrollment and eligibility changes took hold.
What we'd do in the first two weeks
Our Medi-Cal quality measures are already coded and in use with our founding provider network. For CHCA, the work is intake, not invention.
Your plan incentive reports
Alliance CBI plus whatever your other plans send. We reconcile them into one gap list.
An eClinicalWorks extract or registry export
To find care that was delivered but never reached the plan's numerator.
Visits by payer and site
To replace the placeholders above with your actual PPS exposure.
You get back: gaps ranked by the incentive dollars each closure unlocks, a list of recent discharges still inside their 14-day window, and your PPS exposure in one number.
Declared assumptions
- Calculator inputs are illustrative placeholders. CHCA's visit volume, UIS share and rates are unknown to us.
- CBI point allocation is from the Alliance's published 2026 program. Actual payout depends on your linked membership and eligibility thresholds.
- Other plans serving your Stanislaus, Madera, Kern, Fresno and Sacramento sites run different programs, not shown here.
Note: Public sources only. No CHCA data used.
Sources: Alliance 2026 CBI workshop; CBI summary; DHCS sanctions release; DHCS MY24 enforcement report; KVPR on UIS PPS; NHeLP on 2026-27 budget; DHCS 2026-27 Budget Act highlights (PPS delay); Alliance board packet, Dec 2025.