Important Information on the New 2010-2011 Medi-Cal Rates

With the passage of California's budget, the new AB-1629 INTERIM rates for the August 1, 2010 through July 31, 2011 Medi-Cal rate period have been published.  After a long wait this is good news.  However, there are some critical details that we want to bring to your attention. 

Please Note - The rates that have been posted are "Interim" rates.  You should bill at these rates and will be paid at these rates. The rates will be adjusted in the spring of 2011, and you may have to pay money back at that time.

The good news is that the statewide spending cap will be increased by approximately 3.9% which is a very significant and positive change over the freeze that was the law until the new budget was passed.  All providers benefit from this, but not equally.

PLEASE NOTE - your facility will not have a 3.9% increase.  Each individual facility's rate will be calculated independently.  Some individual rates will actually go down, some will go up more than 3.9% and some will remain about the same as last year.

You will be paid an "Interim Rate" and may need to pay money back to the State next spring.

As stated above, the rates that have been published and will be paid are "interim" not final.  On a positive note, the state has used the "normal" AB-1629 formulas in determining the interim rates that have been published.  We have analyzed the available data and have spoken with CAHF about the rates that have been published. We believe that the interim rates will be "pretty close" to the final rates, but not exact.  There are a number of factors that can impact the rates including, inflation factors, peer group limits, Federal matching funds, possible errors in the interim rate calculations, and missing or incorrect data for certain providers.

In spite of these possibilities, it appears as though the interim rates published will be close to the "real" / final rates.  In discussing the possibility of a change in the final rates with a wide variety of people we believe that if you are very conservative in booking your Medi-Cal revenue, you should establish a reserve of about 1%.  We do not know if there will be a reduction, but with caution, we suggest that you plan on some payback in the spring of next year.