Policy Initiatives

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Policy Initiatives

The District Hospital Leadership Forum (DHLF) represents district and municipal 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.

The past year the District Hospital Leadership Forum continues to work on district hospital interests in areas such as:

CalAIM, is a multi-year initiative by DHCS to improve the quality of life and health outcomes of our population by implementing broad delivery system, program and payment reform across the Medi-Cal program. The major components of CalAIM build upon the successful outcomes of various pilots (including but not limited to the Whole Person Care Pilots, Health Homes, and the Coordinated Care Initiative) from the previous federal waivers and will result in better quality of life for Medi-Cal members as well as long-term cost savings/avoidance.

CalAIM has three primary goals:

  • Identify and manage member risk and need through Whole Person Care approaches and addressing Social Determinants of Health;
  • Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
  • Improve quality outcomes and drive delivery system transformation through value-based initiatives, modernization of systems and payment reform.

DHCS formally released the CalAIM proposal on October 29, 2019, at the Stakeholder Advisory Committee (SAC) and Behavioral Health Stakeholder Advisory Committee (BH-SAC) meetings. Throughout the remainder of 2019 and 2020, DHCS will conduct extensive stakeholder engagement for both CalAIM and the renewal of the federal authorities under which Medi-Cal operates (i.e. 1115 and 1915b waivers).

The Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program will build upon the foundational delivery system transformation work, expansion of coverage, and increased access to coordinated primary care achieved through the prior California Section 1115 Bridge to Reform demonstration. Activities supported by the PRIME program are designed to accelerate efforts by participating PRIME entities to change care delivery to maximize health care value and strengthen their ability to successfully perform under risk-based alternative payment models (APMs) in the long term, consistent with CMS and Medi-Cal 2020 goals. The PRIME program is intentionally designed to be ambitious in scope and time-limited. Using evidence-based, quality improvement methods, the initial work will require the establishment of performance baselines followed by target setting and the implementation and ongoing evaluation of quality improvement interventions. Participating PRIME entities will consist of two types of entities: Designated Public Hospital (DPH) systems and the District/Municipal Public Hospitals (DMPH). For more details, please see the PRIME fact sheet.


Beginning January 1, 2021, district/municipal public hospitals (DMPHs) transitioned from PRIME to the Quality Incentive Pool (QIP) program.  QIP shares the goals of PRIME and will allow DMPHs to continue the work on quality initiatives begun in PRIME.  More information on the DMPH QIP can be found in the attachment.

  • The Disproportionate Share Hospital (DSH) Program is a Medi-Cal supplemental payment program. It was established to reimburse hospitals for some of the uncompensated care costs associated with furnishing inpatient hospital services to Medi-Cal beneficiaries and uninsured individuals.
  • There is no application process to become a DSH hospital. Instead, DSH eligibility is determined annually by the Department of Health Care Services using the established Medicaid Utilization Rate (MUR) and Low-Income Utilization Rate (LIUR) formulas. The MUR calculates the ratio of Medi-Cal days to the total patient days. The LIUR calculates the ratio of Medicaid/Medi-Cal revenue to the total paid patient revenue. To be eligible the hospital must have a LIUR in excess of twenty five percent with a MUR of at least one percent, or a MUR of at least one standard deviation above the statewide mean.
  • DSH payments are calculated for eligible hospitals and are disbursed in cycles throughout the state’s fiscal year. An amount totaling to eleven twelfths of the estimated annual total is disbursed during the applicable state fiscal year. The remaining amount is disbursed upon finalization of the annual total.
  • The types of hospitals and/or health facilities that are eligible to participate in the DSH Program consist of general acute care hospitals, acute psychiatric hospitals, and psychiatric health facilities.


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    • Phone (916) 673-2020