Medicaid Nursing Home Rates by State

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California

Medicaid nursing facility payment · Cost-based · researched October 2026

California’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Cost-based

Case-mix level

None

Classification

None

Rate updates

Once a year

Managed care (LTC)

Yes

Quality program

None

Paid outside the rate

Small

Bed hold

Hospital and leave

Published rates

Rates and build‑ups

Assisted living

Limited

Personal needs allowance

$35 / month

Overview

• Medi-Cal pays each freestanding nursing home (FS/NF-B) its own prospective per diem built from its audited Medi-Cal cost report (Medi-Cal Long-Term Care Reimbursement Act, AB 1629, 2004).
• Each cost category is capped at a percentile of the home's geographic peer group (labor 95th, non-labor 75th, admin 50th, liability insurance 75th), capital is paid by fair rental value, and pass-throughs (property tax, license fee, the QAF) are added.
• The capped total is then held to a growth limit: the labor part can rise at most 5% a year per home and the non-labor part 1% in aggregate, so 856 of 895 continuing homes are paid below their capped cost in CY 2026.
• Homes that opt into the Workforce Standards Program (WSP: union contract, labor-management committee, or state wage/benefit floor) get an 'enhanced' rate with a workforce adjustment on top (weighted average $21.98/day in CY 2026).
• CY 2026 continuing homes: median basic rate $302.46/day (range $187.32-$484.43), median enhanced $324.16; statewide weighted average $282.55 basic (pre-QAF) / $304.53 enhanced.

What matters in California

• 856 of 895 homes are paid below their capped cost in CY 2026 because growth is limited to 5% labor, 1% non-labor.
• $21.98/day weighted average extra goes to homes meeting workforce standards: union contract, labor committee or state wage floor.
• Since 1/1/2023 Medi-Cal plans in all counties cover long-term nursing home care and must pay at least the fee-for-service rate.
• About $305M/yr quality pool (WQIP) ended 1/1/2026; outside-rate revenue for freestanding homes is now near zero.
• From 1/1/2028, proposed SPA 26-0010 allows rate growth only for new mandates unless the law is reauthorized.
• $18.48 per resident day provider fee on all payers in CY 2026, returned only on Medi-Cal days, no high-Medicaid discount.

Frequently asked

What limits annual growth in California Medi-Cal nursing home rates?

In CY 2026, 856 of 895 homes are paid below their capped cost because rate growth is limited to 5% for labor and 1% for non-labor costs.

Does Medi-Cal managed care pay California nursing homes less than the fee-for-service rate?

No. Since 1/1/2023 plans in all 58 counties cover nursing home care and must pay at least the fee-for-service rate.

What is California's 2026 quality assurance fee, and does it vary by home size?

The CY 2026 fee add-on is $18.48 or $20.70 per resident day, depending on a 100,000 resident-day size threshold. It applies to all payers and is returned only on Medi-Cal days.

How much is paid outside the posted rate in California?

Near zero for 2026 dates of service; through CY 2025 the WQIP pool added about 5-6% of base.

What does California Medicaid pay on Medicare coinsurance days?

Medi-Cal plans pay full Part A coinsurance; fee-for-service pays only the Medi-Cal rate minus Medicare's payment, usually $0.

Does California require a minimum share of spending on care?

No general rule; wage and benefit standards apply only to homes opting into the enhanced rate.

How is the California nursing home provider tax charged?

$18.48 per resident day on all payers in CY 2026, returned only on Medi-Cal days; CCRC, public and hospital-based homes are exempt.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

California Integrated Long-Term Care Disclosure and Medi-Cal Cost Report (filed with HCAI, formerly OSHPD; due 120 days after fiscal year end), audited by DHCS at least every 3 years (subacute units yearly), plus supplemental schedules (e.g. caregiver training, liability insurance).

Base year and rebasing

Rebased every year: each calendar rate year uses the most recent audited cost report (CY 2026 rates mainly use FYE 2023 reports, trended 36 months to the 7/1/2026 midpoint). SPA 26-0010 states the rule as FYE three years before the rate year or the most recent audited report. Rate year = calendar year since 1/1/2021 (Aug-Jul before that). Annual rebasing is muted by the growth limit, so most homes' rates follow last year's rate x 1.05 (labor) and the 1% non-labor factor, not their cost.

Components

Component	Method	Notes
direct resident care labor	Cost-based, capped at the 95th percentile of the peer group (90th before 8/1/2020); labor inflation index applied from the cost report midpoint to the rate-year midpoint.	Nursing, social services and activities wages and benefits, including agency staff. CY 2026 caps: $221.33 (San Joaquin Valley) to $321.40 (Bay Area).
indirect care labor	Cost-based, capped at the 95th percentile of the peer group; labor inflation index.	Housekeeping, laundry, dietary, medical records, in-service education, plant operations. CY 2026 caps $54.63-$92.30.
indirect care non-labor	Cost-based, capped at the 75th percentile of the peer group; California CPI.	CY 2026 caps $40.04-$51.67.
administrative	Cost-based, capped at the 50th percentile (median) of the peer group; California CPI. Excludes legal fees for litigation against government until resolved in the home's favor.	CY 2026 caps $45.24-$57.88. Includes home office and property insurance.
professional liability insurance	Cost-based, capped at the 75th percentile of the peer group (since 8/1/2010).	CY 2026 caps $6.20-$11.43.
capital (FRVS)	Fair rental value; see capital field. Aggregate FRVS growth capped at 8%/yr.	CY 2026 median $13.86/day.
direct pass-through	Medi-Cal share of property tax (trended 2%/yr), caregiver training cost, facility license fee, and the Medi-Cal share of the quality assurance fee (QAF).	The QAF add-on is $18.48/day in CY 2026 for most homes (see provider_tax_detail).
growth limit (AB 186)	Final labor component = lesser of pre-growth labor (capped cost + new mandates) or last year's final labor x 1.05; final non-labor = lesser of pre-growth non-labor or last year's x the non-labor growth factor (1.02% facility factor in CY 2026, set so the weighted aggregate rises exactly 1%). New mandates (e.g. SB 616 sick leave, +0.769% of labor) are added on top.	CY 2026 statewide weighted averages: pre-growth labor $238.85 vs final $205.95 (86.2%); pre-growth non-labor $105.01 vs final $72.73 (69.3%).
Workforce Standards Program adjustment	Opt-in add-on (Supplement 6 to 4.19-D). CY 2024 = pre-growth labor minus final labor; CY 2025-2027 = prior year's adjustment x 1.05; capped so labor + adjustment does not exceed pre-growth labor.	CY 2026 weighted average $21.98/day (peer groups $16.43-$34.65).

Inflation

Labor: DHCS labor inflation index updated yearly (cost-report wage data, BLS, CMS market baskets, Department of Finance forecast); CY 2026 factor 1.1257 over 36 months for a 7/1/2023 midpoint. Non-labor and admin: California CPI-U (Department of Finance); CY 2026 factor 1.0808. Property tax: 2%/yr. License fees and QAF: not inflated. Applied from the cost-report midpoint to the rate-year midpoint (July 1).

Verified October 11, 2026

Case mix

System

None

Applied at

None

How it works

Medi-Cal pays one flat per diem per home for every NF-B resident regardless of acuity; APL 26-010 says FFS SNF rates 'are not tiered according to the level of care'. The only acuity split is by level: NF-B vs subacute (ventilator / non-ventilator) units, which have separate rates.

Classification

none

Applies to

n/a

Acuity measured from

n/a. Costs are not case-mix neutralized before peer-group percentile caps are applied.

Updated

n/a

Move to PDPM

Not applicable. California never used RUG case mix for NF-B Medi-Cal rates, so the Oct 2023 end of CMS OBRA RUG support had no rate effect. MDS is used only for quality programs (WQIP through 2025, ASP sanctions).

Verified October 11, 2026

Low-acuity residents

None. No reduced or flat rate for low-acuity residents: the per diem is the same for every Medi-Cal NF-B resident in a home. Residents who do not meet nursing-facility level of care are not covered (Treatment Authorization / plan prior authorization), not paid at a lower rate. A separate, lower class exists for Level-A (intermediate care) nursing facilities (NF-A), a different licensed facility type, not a carve-out inside an NF-B home. Checked: Supplement 4 to 4.19-D, APL 26-010, LTC Rates Policy Letter 26-001.

Verified October 11, 2026

Capital

Fair Rental Value System (Supp. 4 V.C.5). Building value = 400 sq ft/bed (500 sq ft and +20% cost for homes built on/after 1/1/2016) x licensed beds x R.S. Means construction cost x location index, trended yearly. Plus $4,000/bed equipment. Depreciated 1.8%/yr on facility age up to 34 years (floor = fully depreciated value). Plus land at 10% of building value. Times a rental factor = prior-year average 20-year Treasury + 2 points, floor 7%, ceiling 10%. Divided by the greater of actual resident days or days at the statewide average occupancy. Renovations of >= $500/bed lower the age (converted to equivalent new beds). Value is not reset by a sale. Aggregate FRVS growth is capped at 8% of the prior year, with proportional cuts to all homes if exceeded. CY 2026 median $13.86/day (range $11.62-$40.20).

Verified October 11, 2026

Budget adjustment factor

(1) AB 186 growth limit, CY 2023-2027: labor component capped at +5%/yr per home (+5% aggregate in CY 2023), non-labor at +1% aggregate (+2% in CY 2023), plus new mandates. It binds for 856 of 895 continuing homes in CY 2026. Statewide, final labor is 86.2% and final non-labor 69.3% of capped cost. (2) Proposed SPA 26-0010 (submitted 8/11/2026) sets growth for rate years beginning on or after 1/1/2028 at ONLY the cost of new mandates (0% otherwise), and the WSP adjustment ends 12/31/2027, unless the Act is reauthorized (the SNF Value Strategy targets 1/1/2028). (3) FRVS aggregate growth cap 8%. (4) Historical: 10% payment cut 6/1/2011-7/31/2012 (later repaid); 0% weighted-average growth in 2009-10; aggregate weighted-average caps of 2.4%-8% each year 2005-2022.

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

small

Estimate

For 2026 dates of service, near zero for freestanding homes: WQIP ended 12/31/2025 and no supplemental program replaced it. Through CY 2025 it was moderate, about 5-6% of base: WQIP $304.8M vs a base of roughly $5.4B. That base is derived from the CY 2026 rate study's ~17.9M annualized Medi-Cal days for 895 continuing homes x ~$305/day. CY 2025 WQIP lump sums are still being paid by plans in 2026-27. Public hospital distinct-part NFs had separate pass-through payments (size not found).

Components

WQIP directed payment (CY 2023 ~$280M, CY 2025 up to $304.8M; ended); public DP/NF pass-through payments CY 2023-2025 (size unknown); ASP sanctions are a negative flow (max $450k/home/yr).

Source

https://www.dhcs.ca.gov/file/ca-fee-nf-renewal-20250101-20251… ; https://leginfo.legislature.ca.gov/faces/codes_displaySection… ; https://www.dhcs.ca.gov/wp-content/uploads/2025/12/CY2026-FSN…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

(1) Public distinct-part (hospital-based) NFs: three-year (CY 2023-2025) managed care pass-through payments in the 31 newly carved-in counties, replacing FFS supplemental payments only public DP/NFs could receive. (2) State-owned and operated freestanding homes (e.g. Veterans Homes of California) are paid the peer-group weighted average rate instead of their own cost and are exempt from the QAF. (3) Public-entity SNFs are QAF-exempt and get no QAF add-on. Private freestanding homes have no ownership-based extra payments. Sizes not found.

Funding

Public DP/NF supplemental payments were historically funded by the public hospital's own funds (IGT/CPE); exact mechanism not confirmed. No lease/management arrangement for private operators found.

Source

https://www.dhcs.ca.gov/file/apl26-010-pdf/ ; https://www.dhcs.ca.gov/wp-content/uploads/2025/12/CY2026-FSN…

Verified October 11, 2026

Quality program

Active

No

Program

Skilled Nursing Facility Workforce and Quality Incentive Program (WQIP), W&I 14126.024 (AB 186, 2022). Ran for CY 2023-2025 and replaced the Quality and Accountability Supplemental Payment (QASP, $84M/yr pool, 2013-2022). The 2025-26 Budget (AB 116, Stats. 2025 ch. 21) made 14126.024 inoperative 1/1/2026: no WQIP for 2026 dates of service, and no successor incentive has been enacted. The remaining quality lever is the penalty-only Accountability Sanctions Program (ASP; see mds_accuracy_penalties/not_in_template). DHCS's 'SNF Value Strategy' is designing the post-2027 framework.

Funding

Managed care state directed payment (42 CFR 438.6(c)) built into capitation as a separate payment term; non-federal share from the SNF QAF and General Fund. Statute targeted $280M for CY 2023, growing each year by the AB 186 rate increases, plus amounts equal to the 1% non-labor aggregate increase in CY 2024 and 2025.

Size

CY 2025: up to $304,825,403 (CMS preprint approval CA_VBP_NF_Renewal_20250101-20251231), about $14.85 per projected WQIP-qualifying day (20,530,846 days). CY 2023 target $280M. CY 2026: $0 (program ended).

Paid as

Per diem x the home's WQIP-qualifying managed care days, paid by each plan as lump sums (interim and final) after the year. Days paid FFS, out of network, or where Medi-Cal is secondary do not count.

Measures

Measure	Source	Weight	How points are earned
Acuity-adjusted staffing hours (total nursing, weekend total nursing, RN, LVN, CNA), scaled by PBJ data completeness vs the 3.5 HPPD / 2.4 CNA state minimums	PBJ / Care Compare	40% (30% Jan-Sep 2025, 10% Oct-Dec 2025)	0-6 points per metric at the 25th/37.5th/50th/62.5th/75th/90th percentiles of CY 2024 California data
Nursing staff turnover	PBJ / Care Compare	15%	0-6 points by percentile; no improvement points
Long-stay weight loss, falls with major injury, antipsychotic use (antipsychotic max 5 points)	MDS QM	19%	Achievement by percentile, or improvement by % gap closure toward the 90th (75th for antipsychotic), above an ASP-based achievement floor; 90% MDS completeness needed (50% penalty at 90-95%)
Outpatient ED visits per 1,000 long-stay days; healthcare-associated infections requiring hospitalization; potentially preventable 30-day post-discharge readmission	Medi-Cal claims/encounters	19%	Percentile benchmarks
Medi-Cal disproportionate share (Medi-Cal days / total days)	Medi-Cal bed days + PBJ census	7%	Higher Medi-Cal share earns more points

Scoring period

CY 2025: staffing Jan-Dec 2025; turnover ~Oct 2024-Sep 2025; MDS clinical Jul 2024-Jun 2025; claims and equity CY 2025. Interim report issued 6/10/2026 (staffing only, prorated); final per diems to plans planned Q4 2026, i.e. about a year after the program year ends. CMS cut HSAG's MDS access in Sept 2024, delaying CY 2024-2025 scoring.

Payment formula

Facility score (0-100) x curve factor (100 / Medi-Cal-day-weighted average score, capped at 100/35 = 2.86) = curved score (can exceed 100%) x uniform per diem ($14.85 in CY 2025) = facility per diem; x qualifying days. Not a fixed pool: dollars are at risk on actual utilization.

Eligibility

Freestanding NF-B network providers of Medi-Cal plans. Excluded: distinct-part (hospital) NFs, freestanding pediatric subacute, homes with 100% special treatment program (STP) beds. Class AA citation in the year = no payment; Class A citation = 40% cut, recouped if issued later.

Cadence

Annual program year (calendar year); interim and final lump sums via plans, 45 days after DHCS sends per diem exhibits.

Scores published

Yes. Per-facility interim/final payment reports (xlsx) at https://www.dhcs.ca.gov/services/wqip-payment-reports-2023-to… and a quarterly performance report on the CalHHS Open Data Portal (https://data.chhs.ca.gov/dataset/workforce-quality-incentive-…).

Notes

QASP (2013-2022): three tiers by a 100-point MDS/staff-retention score, Tier 3 per diem = 1.5 x Tier 2, funded by setting aside 1% of the rate increase plus PLI savings and staffing penalties. WQIP CY 2024 final report issued 12/30/2025.

Verified October 11, 2026

Provider tax

Charged

per resident day (all payers, including Medicare days)

Standard amount

CY 2025 (CMS-approved): $21.60 per resident day for homes with fewer than 100,000 resident days/yr. CY 2026: the rate study's QAF add-on table shows $18.48 (down $3.12), which implies the CY 2026 fee; DHCS's QAF page still lists 2025 as the latest approved rate. Draft CY 2027: $18.48 (unchanged). The fee is set to 6% of aggregate net revenue (H&S 1324.21(b)(2)(B)).

Tiers

Who	Test	Amount
Homes with 100,000 or more resident days per year (very large homes)	volume	CY 2025 $20.74 (lower than standard); CY 2026 $20.70 (now HIGHER than the $18.48 standard)
SNF that is part of a continuing care retirement community (H&S 1771 definition)	ccrc	exempt
SNF operated by the state or another public entity	public	exempt
Distinct-part SNF of a general acute care hospital	hospital_based	exempt
Freestanding pediatric subacute units; SNFs certified for a special treatment program that are IMDs	other	exempt

Lower for high-Medicaid homes

no

Returned in the rate

Each Medi-Cal per diem includes a 'QA Fee Add-On' pass-through equal to the per-day fee ($18.48 for most homes in CY 2026), so Medi-Cal days are made whole. Fee paid on Medicare and private days is not returned; it is the state share that funds the program. Exempt homes get no add-on.

Source

https://www.dhcs.ca.gov/providers-partners/skilled-nursing-fa… ; https://www.dhcs.ca.gov/file/dhcs-9116-032020-snf-pdf/ ; https://leginfo.legislature.ca.gov/faces/codes_displaySection… ; https://www.dhcs.ca.gov/wp-content/uploads/2025/12/CY2026-FSN…

Verified October 11, 2026

Provider tax notes

Skilled Nursing Facility Quality Assurance Fee (QAF), H&S 1324.20-1324.30 (AB 1629). A per-resident-day fee on ALL resident days (all payers including Medicare, Medicare Advantage, private pay and bed hold days) set to raise 6% of aggregate projected net revenue. CY 2025: $21.60/day (<100,000 resident days/yr) and $20.74 (>=100,000). CY 2026 QAF add-on in rates: $18.48 / $20.70. Returned only on Medi-Cal days, as a per diem pass-through equal to the fee. Exempt: CCRCs, state/public homes, hospital distinct parts, freestanding pediatric subacute units, IMD/STP homes. Extended by SB 165 (2026) through 12/31/2027.

Verified October 11, 2026

Supplemental payments

(1) WQIP managed care directed payment, CY 2023-2025 only ($304.8M CY 2025; ended 12/31/2025). (2) LTC FFS-equivalent directed payment: requires plans to pay the FFS per diem; a rate floor, not extra money. (3) Pass-through payments (42 CFR 438.6(d)(6)) for PUBLIC distinct-part nursing facilities for in-network days in the 31 newly carved-in counties, CY 2023-2025 (three years), replacing FFS supplemental payments those public hospital DP/NFs would otherwise have received. Size not found. (4) No provider-tax-funded add-on besides the QAF pass-through in the rate. (5) QASP lump sums ended 12/31/2022.

Verified October 11, 2026

Other add-ons

(1) Workforce Standards Program enhanced rate (opt-in): CY 2026 weighted average +$21.98/day (median home +$21.26, max +$94.11). Three pathways: collective bargaining agreement covering a majority of direct care workers, membership in a DHCS-certified statewide labor-management committee, or paying DHCS's county basic wage and health benefit standards. A home that opts out or misses the 105-day compliance attestation gets the basic rate retroactive to Jan 1. (2) New-mandate add-ons, e.g. SB 616 paid sick leave +0.769% of labor cost until FYE 2024 reports are used. Minimum wage increases get no separate add-on. (3) Special treatment program (STP) mental health supplement $5.72/day (22 CCR 51511.1). (4) The COVID-19 10% per diem increase (2020-2023) was discontinued 1/1/2024 and audited (85% had to go to added labor in CY 2023).

Verified October 11, 2026

Units paid separately

(1) Freestanding adult subacute units (FSSA): their own cost-based rate study, one statewide peer group, separate ventilator / non-ventilator rates, 12 months of subacute cost data required. (2) Pediatric subacute (freestanding FS/PSA and distinct part DP/PSA): separate rates; QAF-exempt; outside WQIP. (3) Distinct-part (hospital-based) NF-B (DP/NF-B): NOT under AB 1629. Paid the lower of the home's projected cost or the class median projected cost (homes with <20% Medi-Cal excluded from the median); calendar rate year since 1/1/2024 (SPA 23-0032). CY 2027 DP/NF-B rate study already posted for public review. State-operated DP/NFs paid audited cost. (4) IMDs are excluded from the AB 1629 method. (5) State-owned homes (e.g. Veterans Homes of California), newly certified homes, religious nonmedical institutions and recertified homes get the peer-group weighted average rate; out-of-state homes get the statewide weighted average ($282.55 CY 2026). (6) NF Level-A, rural swing beds, and hospital administrative days have separate rate classes. (7) Hospice room and board = 95% of the home's facility-specific rate.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

yes

Detail

CalAIM LTC carve-in: since 1/1/2023 all Medi-Cal managed care plans in all 58 counties must cover SNF long-term care (freestanding and hospital-based) with no day limit; most non-dual and dual LTC members, including those with a share of cost, must be enrolled in a plan. Before 2023, plans in 31 counties covered only the month of admission plus one month, then disenrolled the resident to FFS. Adult and pediatric subacute and ICF/DD followed 1/1/2024. Source: APL 26-010 (6/10/2026, supersedes APL 24-009); W&I 14184.201(b).

Verified October 11, 2026

Who pays

managed_ltss (Medi-Cal managed care plans under CalAIM; SNF long-term care carved into managed care statewide 1/1/2023, subacute 1/1/2024). Fee-for-service now pays only residents not yet or not required to be enrolled in a plan.

Verified October 11, 2026

Managed care rate floor

Yes, and stronger than a floor. W&I 14184.201(b)(2) and APL 26-010: for 1/1/2023-12/31/2026 plans in the 31 former-FFS counties must pay EXACTLY the facility's Medi-Cal FFS per diem rate on file, and plans in the 27 counties that already covered SNF must pay NO LESS than it. DHCS extended the requirement through 12/31/2026 and may extend further by APL. It covers the per diem, leave-of-absence and bed-hold days, not ancillaries, out-of-network days or incentive payments. It is a 42 CFR 438.6(c) directed payment (LTC FFS-Equivalent Directed Payment, CA.VBP_NF.Oth_New_20230101-20251231). Plans must apply retroactive rate changes within 45 working days of DHCS notice and pay 15% interest when late. Sources: https://www.dhcs.ca.gov/file/apl26-010-pdf/ ; https://leginfo.legislature.ca.gov/faces/codes_displaySection… ; https://www.dhcs.ca.gov/services/long-term-care-fee-for-servi…

Verified October 11, 2026

Included in the daily rate

Routine services only (Supp. 4 II.B-D; 22 CCR 51511): room, board, nursing, and commonly used equipment, supplies and services under 22 CCR 51511(b). Excluded and billed separately: ancillary services (therapy, lab, X-ray, etc.) and items listed in 22 CCR 51511(c). Legend (prescription) drugs are not in the per diem: pharmacy-claim drugs are carved out to Medi-Cal Rx, and drugs the SNF bills on an institutional claim are the plan's responsibility (APL 26-010). Personal items (cosmetics, dry cleaning, beauty shop, TV rental) are excluded. Subacute per diems are broader and include all services, equipment and supplies for subacute treatment (22 CCR 51511.5(d)). The per diem is limited to the home's usual charge to the general public.

Verified October 11, 2026

Bed hold

Hospital stays

Paid: up to 7 days per acute hospitalization (22 CCR 51535.1), physician-ordered, bed held vacant. Paid at the home's daily rate minus a raw-food deduction ($9.95/day CY 2026; $10.45 draft CY 2027), i.e. about 97% of the per diem. Plans must cover bed holds at the FFS rate and may not require re-authorization for returns within 7 days (APL 26-010).

Leave days

Paid leave of absence (22 CCR 51535): 18 days per calendar year, plus up to 12 more days if in the care plan; 73 days for developmentally disabled residents; 30 days for special treatment program / mental health residents. Paid at the rate less the same raw-food deduction.

Occupancy rule

None.

Notes

Bed hold and leave days count as resident days for the QAF.

Source

https://www.law.cornell.edu/regulations/california/22-CCR-515… ; https://www.law.cornell.edu/regulations/california/22-CCR-51535 ; https://www.dhcs.ca.gov/file/ltc-rates-pl-26-001-snf-cy2026-pdf/

Verified October 11, 2026

Personal needs allowance

Per month

35

Effective

long-standing (pre-2000)

Notes

22 CCR 50605: $35 for personal and incidental needs when in LTC the whole month; therapeutic-wage earners get $35 plus 70% of gross therapeutic earnings. Not COLA-indexed. Compilation also cites $62 for SSI recipients (not verified).

Confidence

confirmed

Source

https://www.law.cornell.edu/regulations/california/22-CCR-50605

Verified October 11, 2026

Medicare coinsurance days

Method

full

Rule

Managed care (where nearly all dual-eligible SNF residents now are, since the 2023 carve-in): APL 26-010 says plans 'must pay the full deductible and coinsurance' for SNF services to dual eligibles, per APL 13-003. Fee-for-service: W&I 14109.5 limits Medicare cost-sharing payments to no more than the Medi-Cal rate for similar services, i.e. lesser-of. Medicare Advantage cost-sharing for duals in plans was not separately confirmed.

Effect

For dual residents enrolled in a Medi-Cal plan, the home should receive the full Part A day 21-100 coinsurance. In FFS, it gets at most the Medi-Cal per diem minus what Medicare paid, usually $0.

Confidence

likely

Source

https://www.dhcs.ca.gov/file/apl26-010-pdf/ ; https://leginfo.legislature.ca.gov/faces/codes_displaySection…

Verified October 11, 2026

Required care spending

Applies

no

Rule

No current rule requiring a share of Medi-Cal revenue to be spent on care. Related: (a) the WSP is optional: homes taking the enhanced rate must keep a union contract or labor-management committee membership, or pay county basic wage and health-benefit standards, with retroactive loss of the adjustment if they fail; (b) CY 2023 only: 85% of the COVID-19 10% rate increase had to be spent on added labor costs, with recoupment of any shortfall (audits ongoing); (c) state minimum staffing of 3.5 direct care hours per patient day (2.4 CNA) is a licensing rule, not a payment rule.

Source

https://www.dhcs.ca.gov/file/supplement-4-to-attach-4-19-d-pdf/ ; https://www.dhcs.ca.gov/services/medi-cal-resources/skilled-n…

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

Capital (FRVS) per diem = fair rental value divided by the GREATER of actual resident days or days at the statewide average occupancy rate, so homes below state-average occupancy get less capital per day. No occupancy test on operating components or bed holds.

Source

https://www.dhcs.ca.gov/file/supplement-4-to-attach-4-19-d-pdf/

Verified October 11, 2026

MDS accuracy penalties

None tied to case mix (no case-mix payment). Related quality penalty: the Accountability Sanctions Program (ASP, W&I 14126.026, from measurement year 2024). Freestanding SNFs that miss national-percentile benchmarks on long-stay falls with major injury, weight loss or antipsychotic use pay $1-$5 per Medi-Cal bed day per measure (sliding scale), capped at $150,000 per measure per year ($450,000 total in MY 2026), deductible from Medi-Cal payments. Source: https://www.dhcs.ca.gov/file/snf-asp-policy-letter-25-004-pdf/

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

annual

When

Calendar rate year starting January 1 (since 2021). Rates on file are often published months late and then applied retroactively: CY 2024-2026 'rates on file' reflecting WSP opt-ins were re-posted September 15, 2026, and homes are paid the prior rate on file until the new one is published. Plans must apply retroactive changes within 45 working days. No case-mix or mid-year acuity changes.

Verified October 11, 2026

When rates change

January 1 (calendar year), set prospectively from the annual rate study. Policy letter for CY 2026 issued 10/31/2025; CY 2027 public-review draft posted with comments due 10/16/2026, contingent on CMS approval of SPA 26-0010. Mid-year: retroactive WSP opt-in/opt-out rate swaps, audit-appeal recomputations, CHOWs (the new operator keeps the prior operator's rate until its own audited cost report has 6 months (12 for subacute)), and new mandates.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://www.dhcs.ca.gov/services/medi-cal-resources/freestand… ('Published Rates on File' per CY; older years under the Rates Archive page)

Format

xlsx (rates on file and rate studies)

Cadence

Annual rate study (final model usually Oct-Dec before the rate year) plus re-published rates on file as WSP opt-ins are processed (latest batch 9/15/2026 for CY 2024-2026).

History

CY 2023-2027 (draft) on the main page; 'Rates information older than two years' on the FS/SNF Rates Archive page and the 'AB 1629 Prior Years Rates' page (back to AB 1629 rate years starting 2005-06).

Home identifier

HCAI ID (former OSHPD facility number) and NPI, plus facility name, county and peer group. No CCN.

Verified October 11, 2026

Rate build-ups

Published

Yes

Where

https://www.dhcs.ca.gov/services/medi-cal-resources/freestand…

What they show

Per facility: cost report period, inflation factors, audited and Medi-Cal days, licensed beds, each cost category's audited cost, inflated per diem, peer-group percentile cap and allowed amount, FRVS, license fee, SB 616 add-on, pre-growth labor and non-labor, prior-year final components and growth caps, final labor/non-labor, QAF add-on, final basic rate, workforce rate adjustment, and WSP enhanced rate. Appendix tables give peer-group weighted averages, adjustment factors, percentile caps, the non-labor growth demonstration, QAF and license fees and the bed-hold food deduction. Separate FRVS model workbook.

Format

xlsx

Example file

https://www.dhcs.ca.gov/wp-content/uploads/2025/12/CY2026-FSN…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

limited

Program

Assisted Living Waiver (ALW), 1915(c) HCBS waiver CA.0431, current term 3/1/2024-2/28/2029 (slot expansion amendment eff. 3/1/2025).

What is paid

Services only, in licensed RCFEs/ARFs or public subsidized housing (via home health agencies). Residents pay room and board themselves, mostly from SSI/SSP. Care coordination is paid to Care Coordination Agencies.

Rate

2026 maximum per diems (T2031): Tier 1 $95.69, Tier 2 $114.33, Tier 3 $132.97, Tier 4 $179.58, Tier 5 $270.80 (raised for the 1/1/2026 minimum wage). 2024: $91.13-$257.25. Care coordination $320/participant/month; nursing facility transition $1,600 one-time.

Limits

15 counties only (Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, Sonoma). Enrollment capped by waiver slots with a waitlist. Must be 21+, full-scope Medi-Cal with no share of cost, and at nursing facility level of care.

Source

https://www.dhcs.ca.gov/services/long-term-care-alternatives-… ; https://www.dhcs.ca.gov/file/alw-reimbursement-rates-2024-pdf/

Verified October 11, 2026

Sources

1. DHCS Medi-Cal Long-Term Care Reimbursement page · agency page
2. DHCS Freestanding SNFs and Subacute Units (rates, studies, policy letters) · agency page
3. Supplement 4 to Attachment 4.19-D (FS/NF-B methodology, consolidated) · state plan
4. SPA 24-0004 approval (growth limit 2024-2026, Workforce Standards Program, Supplement 6) · state plan
5. SPA 26-0010 submission (CY 2027 extension; growth from 2028 = mandates only), 8/11/2026, pending · state plan
6. LTC Rates Policy Letter 26-001: FS/SNF CY 2026 Rates (10/31/2025) · agency page
7. CY 2026 FS/NF-B Rate Study (xlsx) · rate file
8. CY 2027 FS/NF-B Rate Study, Public Review Draft (xlsx) · rate file
9. APL 26-010 SNF LTC Benefit Under Managed Care (6/10/2026) · agency page
10. W&I 14184.201 (CalAIM benefit standardization, SNF payment at FFS rate) · statute
11. LTC Fee-for-Service Equivalent Directed Payment page · agency page
12. CalAIM Long-Term Care Carve-In page · agency page
13. SNF WQIP program page (ends 12/31/2025) · agency page
14. SNF WQIP CY 2025 Technical Assistance Guide (HSAG, 9/9/2025) · agency page
15. CMS SDP approval CA_VBP_NF_Renewal_20250101-20251231 (WQIP CY 2025, $304,825,403) · agency page
16. W&I 14126.024 (WQIP; inoperative 1/1/2026 per AB 116) · statute
17. W&I 14126.033 (rate growth limits, WSP authority, sunset 12/31/2027) · statute
18. SB 165 (Stats. 2026, ch. 61) extending the Act and QAF through 2027 · statute
19. DHCS SNF Quality Assurance Fee page (rates by year, tiers) · agency page
20. DHCS 9116 SNF QAF payment form (resident-day definition) · agency page
21. H&S 1324.20-1324.21 (QAF definitions, exemptions, 6% of net revenue) · statute
22. Workforce Standards Program page · agency page
23. Nursing Facility Financing Reform (AB 186) page · agency page
24. SNF Accountability Sanctions Program page · agency page
25. SNF ASP Policy Letter 25-004 (MY 2026) · agency page
26. Distinct Part NF-B (DP/NF-B) rates page · agency page
27. SNF Value Strategy page (reauthorization for DOS on/after 1/1/2028) · agency page
28. 22 CCR 51535.1 Bed hold for acute hospitalization · regulation
29. 22 CCR 51535 Leave of absence · regulation
30. W&I 14109.5 (crossover payments not to exceed Medi-Cal rate) · statute
31. DHCS Assisted Living Waiver page (2026 rates, counties) · agency page
32. ALW Reimbursement Rates 2024 · rate file
33. Personal needs allowance · regulation

Other states

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