Medi-Cal cost reporting: private duty nursing and congregate living health facilities.
The legislation also requires a comprehensive cost study on licensed congregate living health facilities, to be conducted every three years starting in 2026. This study will assess the financial and operational costs associated with these facilities, factoring in various operational aspects such as labor, insurance, and utilities. By institutionalizing regular evaluations, the bill seeks to improve the financial sustainability of these facilities and ensure that they receive adequate funding to provide necessary care, particularly for vulnerable populations.
Senate Bill 1033, introduced by Senator Menjivar, addresses the reimbursement system for Medi-Cal services provided by private duty nursing agencies and congregate living health facilities in California. The bill mandates the State Department of Health Care Services (DHCS) to develop a cost estimate by January 10, 2026, to evaluate and potentially increase reimbursement rates for private duty nursing services for pediatric patients, aimed at aligning Medi-Cal rates closer to those offered under the federal Medicare Program. The proposed increases would involve raising the Medi-Cal rates for these services to 87% and eventually to 100% of corresponding Medicare rates.
General sentiment around SB 1033 appears to be supportive, especially among healthcare providers who advocate for better reimbursement rates to ensure quality care for pediatric patients. However, there may be concerns about funding sources and the potential implications of rate increases on the overall budget for the Medi-Cal program. Advocates argue that improved funding is essential, while some stakeholders may express worries about the long-term fiscal viability of increased state spending on healthcare services.
One significant point of contention relates to the funding mechanisms that will support the increased rates for Medi-Cal services. The bill emphasizes collaboration with providers, families, and other relevant stakeholders in developing the cost studies, but concerns persist regarding whether the state budget can accommodate these changes without adverse effects on other areas of spending. Additionally, there may be debates on the appropriateness of aligning Medi-Cal rates with Medicare rates, considering the differences between these programs and the populations they serve.