Our Background

The District Hospital Leadership Forum (DHLF) represents district hospitals throughout California. DHLF originated from the efforts of a number of public district/municipal hospital Executive teams in an effort to address financial issues of importance related to public district/municipal hospitals. DHLF strives to promote concepts and analyze options that support public district/municipal hospital interests, while providing expert leadership and advocacy in California and federal political realms. The Forum’s specific mission is to improve district/municipal 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.
Medi-Cal 2020, the state’s Section 1115 Medicaid waiver was signed on December 31, 2015 and expires in 2020. The waiver provides public hospitals with federal funding to improve their healthcare delivery systems via the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program.  Unlike prior 1115 statewide waivers, district/municipal public hospitals (DMPHs) are specifically included in Medi-Cal 2020, which is the direct result of ongoing advocacy since the inception of the DHLF in 2010.  Efforts of both the DHLF and members now turn to implementation of the PRIME Program at each hospital.  Subsequent to implementation, efforts will then transition to ensuring the operation of the program meets the needs and goals of all stakeholders, including the state, the Centers for Medicare and Medicaid Services (CMS), and the individual DMPHs.  In addition to advocacy on the Medicaid waiver, the DHLF focuses on other sources of revenue for DMPHs, both ensuring accurate implementation of ongoing programs while identifying new opportunities.  Some of the ongoing programs include the state’s hospital quality assurance fee (HQAF), the fee-for-service inpatient supplemental for DMPHs (the AB 113 program), fee-for-service outpatient supplemental for all public hospitals (the AB 915 program), Medi-Cal managed care supplemental (the rate range programs) and the Medi-Cal disproportionate share hospital (DSH) program.    Other efforts are focused on state and federal proposals which may impact (both negatively or positively) DMPHs.