Our Background

The District Hospital Leadership Forum (DHLF) represents district hospitals throughout California. DHLF originated from the efforts of a number of public District hospital Executive teams in an effort to address financial issues of importance related to public District hospitals. DHLF strives to promote concepts and analyze options that support public District hospital interests, while providing expert leadership and advocacy in California and federal political realms. The Forum’s specific mission is to improve District hospital access to public funding opportunities in both the short term and in the long term.

As the DHLF has undertaken these endeavors, the relationship and coordination with the Association of California Healthcare Districts (ACHD), the other associations representing district hospitals, is being maintained. ACHD through a resolution approved by its Board of Directors agreed to support the efforts of the DHLF and “…recognizes the Forum as the sole voice for public District hospitals in all finance and reimbursement issues.” The DHLF has accepted that responsibility.



District hospitals, with publicly elected Boards of Directors, are local governments responsible for providing for the healthcare needs of their communities. Healthcare districts began to be formed in 1946 and 1947 in response to California’s acute care bed shortage after World War II. Today these healthcare districts are still relied upon as the healthcare access points in many of California’s counties.

California’s public district hospitals provide significant levels of care to the uninsured and Medi-Cal populations. In 19 counties, district hospitals are the only public hospitals within the county. In addition, many of the local residents in the other 9 counties that contain both public district hospitals along with either a county or University of California hospital there is a significant geographic separation that limits the beneficiaries option of seeking care at any other acute care hospital other than the public district hospital.

The DHLF seeks to work toward a remedy to expand access to needed hospital services for all Californians, especially low-income patients, across the state.


The 2010 five-year Section 1115 Medicaid waiver was signed on November 2, 2010. The waiver provides public hospitals with federal funding to expand coverage, improve their healthcare delivery systems, and provided support for the provision of care to the uninsured. While public district and municipal, “non-designated public hospitals (NDPHs)” receive some funding to assist them with their Medicaid underpayments, they did not originally receive any federal funding related to coverage expansion, healthcare delivery system improvement or support for the provision of care to the uninsured. The Special Terms and Conditions related to the Section 1115 waiver, “California Bridge to Reform Demonstration” provides for federal funding streams to public hospitals in an effort to improve the delivery of health care throughout California, and to prepare for the federal health care reform initiatives in 2014. These funding streams are only available to public hospitals because these hospitals have the ability to provide the source of the federal match through the use of either intergovernmental transfers (IGTs) or certified public expenditures (CPEs). Public district hospitals are similar to county and University of California hospitals, having the same ability to provide the required source of the federal match. During discussions related to the waiver, it was pointed out how important it was to include the public district hospitals as part of the waiver in order to ensure that these objectives could be met throughout California, not solely in the limited geographic area covered by the 21 designated public hospitals. However, only 21 pre-selected public hospitals were originally eligible for the $8 billion of federal funding provided in the waiver.

The Department of Health Care Services (DHCS) currently is convening stakeholders, including the DHLF, in a process as they determine components for inclusion in the proposed 2015 Section 1115 Medicaid Waiver. More information will be available here as decisions are determined. Additional information is available at http://.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx.