{
  "version": 1,
  "generatedAt": "2026-09-07T04:32:07.308636+00:00",
  "data": {
    "asOf": "2026-09-26",
    "timeline": [
      {
        "date": "2023-08-24",
        "precision": "day",
        "status": "completed",
        "event": "HCAI released Distressed Hospital Loan Program award determinations.",
        "domain": "subsidy",
        "source": "California HCAI Distressed Hospital Funding Programs"
      },
      {
        "date": "2023-10-05/2024-07-11",
        "precision": "date range",
        "status": "completed",
        "event": "The 16 published DHLP award dates span this period; original awards total $292.5 million.",
        "domain": "subsidy",
        "source": "California HCAI Distressed Hospital Funding Programs"
      },
      {
        "date": "2024-09-28",
        "precision": "day",
        "status": "enacted",
        "event": "AB 869 (Ch. 801, Stats. 2024) enacted: eligible hospitals (DHLP recipients, small <=50 beds, rural, critical access, health-care-district hospitals) may seek HCAI approval to delay the January 1, 2030 seismic deadline by up to 3 years, with a possible further 2-year delay to a maximum of January 1, 2035; seismic compliance plans due by January 1, 2026.",
        "domain": "state policy",
        "source": "California Legislative Information, AB 869 (2023-24) bill text and Legislative Counsel's Digest",
        "url": "https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240AB869",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2025-07-04",
        "precision": "day",
        "status": "enacted",
        "event": "Public Law 119-21 enacted Medicaid provider-tax and state-directed-payment restrictions.",
        "domain": "federal financing",
        "source": "U.S. Congress, Public Law 119-21 sections 71115-71116"
      },
      {
        "date": "2025-12-29",
        "precision": "day",
        "status": "announced",
        "event": "CMS announced Rural Health Transformation Program awards (P.L. 119-21 sec. 71401); HCAI reports California was awarded $233.6 million for federal FY 2026 (HCAI is lead agency, 'CalRHT').",
        "domain": "federal financing",
        "source": "HCAI California Rural Health Transformation (CalRHT) page",
        "url": "https://hcai.ca.gov/rural-health/calrht/",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2026-01-29",
        "precision": "day",
        "status": "final rule",
        "event": "CMS displayed the final health-care-related-tax loophole rule. For California's recently approved MCO tax structure, the transition runs through the end of calendar year 2026.",
        "domain": "federal financing",
        "source": "CMS Preserving Medicaid Funding for Vulnerable Populations final-rule fact sheet"
      },
      {
        "date": "2026-02-02",
        "precision": "day",
        "status": "announced",
        "event": "CMS issued updated preliminary guidance on P.L. 119-21 sec. 71116 state-directed-payment limits and grandfathering, replacing its September 2025 guidance (per DHCS; letter dated 02/02/2026 by filename).",
        "domain": "federal financing",
        "source": "DHCS Medi-Cal Financing: Federal Policy Impacts page (page last updated July 6, 2026), linking CMS SDP letter",
        "url": "https://www.medicaid.gov/medicaid/managed-care/downloads/sdp-letter-02022026.pdf",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2026-04-22",
        "precision": "day",
        "status": "under discussion",
        "event": "The OHCA Health Care Affordability Board received a staff introduction to the spending-target penalty structure and data-submission enforcement regulatory text (informational). The penalty Board vote and regulations are listed as future topics.",
        "domain": "state policy",
        "source": "HCAI OHCA Board April 22, 2026 agenda and presentation",
        "url": "https://hcai.ca.gov/wp-content/uploads/2026/06/April-2026-Board-Meeting-Presentation.pdf",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2026-05-18",
        "precision": "day",
        "status": "completed",
        "event": "Distressed Hospital Small Grant Program application deadline; HCAI later published four determinations totaling $25.0 million.",
        "domain": "subsidy",
        "source": "California HCAI Distressed Hospital Small Grant application and funding-program page"
      },
      {
        "date": "2026-05-22",
        "precision": "day",
        "status": "proposed rule",
        "event": "CMS published the state-directed-payment proposed rule (CMS-2449-P) in the Federal Register; comments closed July 21, 2026. Still proposed as of September 26, 2026.",
        "domain": "federal financing",
        "source": "Federal Register",
        "url": "https://www.federalregister.gov/documents/2026/05/22/2026-10292/medicaid-program-medicaid-managed-care-state-directed-payments-and-medicaid-fee-for-service-targeted"
      },
      {
        "date": "2026-06-03",
        "precision": "day",
        "status": "interim final rule",
        "event": "CMS interim final rule with comment, 'Medicaid Program; Community Engagement Requirement for Certain Individuals' (FR doc 2026-11094), effective 2026-07-31; states must implement no later than January 1, 2027 (correction published 2026-06-29).",
        "domain": "federal financing",
        "source": "Federal Register API, documents 2026-11094 and C1-2026-11094",
        "url": "https://www.federalregister.gov/documents/2026/06/03/2026-11094/medicaid-program-community-engagement-requirement-for-certain-individuals",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2026-06-26",
        "precision": "day",
        "status": "approved",
        "event": "CMS approved the major components of California's Hospital Quality Assurance Fee Program 9 (calendar year 2025), including the tax waiver. DHCS estimates hospital net-benefit payments of $5.5 billion; CHA and a congressional press release cite about $5.9 billion. CHA reports full fee-for-service payment approval remained outstanding.",
        "domain": "federal financing",
        "source": "DHCS 2026-27 Budget Act Highlights (July 1, 2026), p. 5; Rep. David Valadao press release (June 26, 2026); CHA 'CMS Approves Hospital Fee Program 9' (July 2, 2026, member-restricted body)",
        "url": "https://www.dhcs.ca.gov/wp-content/uploads/2026/07/DHCS-FY-2026-27-Budget-Act-Highlights.pdf",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2026-06-29",
        "precision": "day",
        "status": "enacted",
        "event": "SB 125 (Ch. 24, Stats. 2026) enacted to restructure California's MCO tax to conform to P.L. 119-21 / the February 2026 CMS rule; the renewed tax is effective January 1, 2027 (or later upon federal approval). DHCS budget scores $575M (2026-27), $2.3B each in 2027-28 and 2028-29, and $1.7B in 2029-30.",
        "domain": "state policy",
        "source": "California Legislative Information, SB 125 (2025-26) status; DHCS 2026-27 Budget Act Highlights (July 1, 2026), p. 4",
        "url": "https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260SB125",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2026-07-01",
        "precision": "day",
        "status": "enacted",
        "event": "2026-27 Budget Act (DHCS highlights): $250 million one-time General Fund for grants to California's designated public hospital system; MCO-tax revenue of $2.5B in 2026-27 supporting payment increases relative to CY 2024 for hospital and other services, including $1.9B from CY 2025-2026 MCO tax revenue after Proposition 35 requirements.",
        "domain": "state policy",
        "source": "DHCS 2026-27 Budget Act Highlights (July 1, 2026), pp. 4-6",
        "url": "https://www.dhcs.ca.gov/wp-content/uploads/2026/07/DHCS-FY-2026-27-Budget-Act-Highlights.pdf",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2026-07-16",
        "precision": "day",
        "status": "official estimate update",
        "event": "DHCS updated the May 2026 Medi-Cal Local Assistance Appropriation Estimate for the 2026-27 Budget Act.",
        "domain": "state financing",
        "source": "DHCS May 2026 Medi-Cal Local Assistance Appropriation Estimate"
      },
      {
        "date": "2026-07-23",
        "precision": "day",
        "status": "proposed rule",
        "event": "CMS published the provider-tax indirect hold-harmless proposed rule (CMS-2452-P) in the Federal Register; comments closed September 21, 2026. Still proposed as of September 26, 2026.",
        "domain": "federal financing",
        "source": "Federal Register",
        "url": "https://www.federalregister.gov/documents/2026/07/23/2026-14897/medicaid-program-amending-the-indirect-hold-harmless-threshold-of-health-care-related-taxes"
      },
      {
        "date": "2026-10-01",
        "precision": "day",
        "status": "enacted",
        "event": "P.L. 119-21 sec. 71109 (alien Medicaid eligibility restriction) and sec. 71110 (emergency Medicaid FMAP for expansion-group non-qualified immigrants limited to regular FMAP) take effect. DHCS: emergency-services match falls from 90% to 50%; California delays its state transition to restricted-scope Medi-Cal for affected qualified non-citizens to July 1, 2027 (about 148,000 people).",
        "domain": "federal financing",
        "source": "Public Law 119-21 secs. 71109-71110 (govinfo); DHCS 2026-27 Budget Act Highlights p. 4",
        "url": "https://www.govinfo.gov/content/pkg/PLAW-119publ21/html/PLAW-119publ21.htm",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2026-12-31",
        "precision": "day",
        "status": "final-rule transition boundary",
        "event": "California's current MCO tax remains permitted through its authorized term; DHCS states the same tax structure will no longer be federally approvable afterward.",
        "domain": "state financing",
        "source": "DHCS Medi-Cal Financing page; CMS January 29, 2026 final-rule fact sheet"
      },
      {
        "date": "2027-01",
        "precision": "month; LAO assumption",
        "status": "official projection, not enacted implementation date",
        "event": "LAO assumes federal changes begin affecting California's private hospital fee when waiver authority is renewed.",
        "domain": "state financing",
        "source": "LAO 2026-27 Medi-Cal Fiscal Outlook"
      },
      {
        "date": "2027-01-01",
        "precision": "day",
        "status": "enacted",
        "event": "P.L. 119-21 Medi-Cal eligibility provisions start: community engagement requirement (sec. 71119), six-month redeterminations for expansion adults (sec. 71107), and shorter retroactive coverage (sec. 71112; DHCS: one month for expansion adults, two months for others). Each begins in the first quarter after December 31, 2026.",
        "domain": "federal financing",
        "source": "Public Law 119-21 secs. 71107, 71112, 71119 (govinfo); DHCS 2026-27 Budget Act Highlights p. 4",
        "url": "https://www.govinfo.gov/content/pkg/PLAW-119publ21/html/PLAW-119publ21.htm",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2027-10-01",
        "precision": "FFY 2028 start",
        "status": "enacted phase-down; rulemaking in progress",
        "event": "Provider-tax safe-harbor ceiling begins its statutory phase-down for Medicaid expansion states.",
        "domain": "federal financing",
        "source": "P.L. 119-21 section 71115; CMS July 21, 2026 proposed-rule fact sheet"
      },
      {
        "date": "2028-01-01",
        "precision": "rating-period threshold",
        "status": "enacted transition",
        "event": "Qualifying grandfathered state-directed payments begin 10-percentage-point annual reductions toward the new limit.",
        "domain": "federal financing",
        "source": "P.L. 119-21 section 71116; DHCS Medi-Cal Financing page"
      },
      {
        "date": "2028-10-01",
        "precision": "day",
        "status": "enacted",
        "event": "P.L. 119-21 sec. 71120 cost sharing for expansion adults above 100% FPL begins.",
        "domain": "federal financing",
        "source": "Public Law 119-21 sec. 71120 (govinfo)",
        "url": "https://www.govinfo.gov/content/pkg/PLAW-119publ21/html/PLAW-119publ21.htm",
        "addedOn": "2026-09-26"
      },
      {
        "date": "2031-10-01",
        "precision": "FFY 2032 start",
        "status": "enacted target",
        "event": "Provider-tax safe-harbor ceiling reaches 3.5% for Medicaid expansion states.",
        "domain": "federal financing",
        "source": "P.L. 119-21 section 71115; LAO 2026-27 Medi-Cal Fiscal Outlook"
      },
      {
        "date": "2031-12-31",
        "precision": "day",
        "status": "scheduled",
        "event": "Distressed Hospital Loan Program statutory sunset.",
        "domain": "subsidy",
        "source": "California HCAI Distressed Hospital Funding Programs"
      }
    ],
    "facts": [
      {
        "label": "FY 2026\u201327 Medi-Cal appropriation",
        "value": 219655102000,
        "unit": "dollars, all funds",
        "source": "DHCS May 2026 Medi-Cal Local Assistance Appropriation Estimate, Funding Summary, page FS 1",
        "caveat": "Program-wide appropriation; not a hospital-only amount."
      },
      {
        "label": "Hospital Quality Assurance revenue",
        "value": 9853027000,
        "unit": "dollars, FY 2026\u201327",
        "source": "DHCS May 2026 Medi-Cal Local Assistance Appropriation Estimate, Funding Summary, page FS 2",
        "caveat": "Financing line item; not equivalent to net hospital benefit."
      },
      {
        "label": "Managed-care private-hospital directed payments",
        "value": 6291696000,
        "unit": "dollars, FY 2025-26 estimate",
        "source": "DHCS May 2026 Medi-Cal Local Assistance Estimate, Summary of Regular Policy Changes, page CY 7",
        "caveat": "Official program-level total-funds estimate; it is not a post-policy loss estimate or a facility allocation."
      }
    ],
    "resources": [
      {
        "topic": "Federal policy impacts",
        "url": "https://www.dhcs.ca.gov/federal-impacts/Pages/financing.aspx",
        "use": "Best current California implementation source for MCO-tax, provider-tax, and state-directed-payment status."
      },
      {
        "topic": "Hospital Quality Assurance Fee",
        "url": "https://www.dhcs.ca.gov/providers-partners/hospital-quality-assurance-fee-program-hqaf/",
        "use": "Document fee cycles, supplemental payments, and directed-payment context."
      },
      {
        "topic": "Distressed Hospital Loan Program",
        "url": "https://hcai.ca.gov/facilities/health-facility-financing/distressed-hospital-loan-program/",
        "use": "Identify statutory stabilization support and program status."
      }
    ],
    "subsidies": {
      "source": "California HCAI, Distressed Hospital Funding Programs page, retrieved from the public official page in this source run.",
      "sourceUrl": "https://hcai.ca.gov/facilities/health-facility-financing/distressed-hospital-loan-program/",
      "smallGrants2026": {
        "program": "Distressed Hospital Small Grant Program",
        "authorizedFunding": 25000000,
        "awardDeterminations": [
          {
            "facilityName": "Southern Inyo Healthcare District",
            "amount": 400000
          },
          {
            "facilityName": "Palo Verde Hospital",
            "amount": 3000000
          },
          {
            "facilityName": "Watsonville Community Hospital",
            "amount": 10600000
          },
          {
            "facilityName": "El Centro Regional Medical Center",
            "amount": 11000000
          }
        ],
        "awardCount": 4,
        "awardTotal": 25000000,
        "caveat": "The page describes award determinations and says HCAI was finalizing grant agreements and would distribute funds after execution. These are not payment-confirmation records; unencumbered funds were to revert on June 30, 2026."
      },
      "dhlpLoans": {
        "program": "Distressed Hospital Loan Program",
        "awardDeterminations": [
          {
            "facilityName": "Chinese Hospital",
            "amount": 10350000,
            "awardDate": "2023-11-06",
            "step1Modification": "Yes",
            "step2Modification": "Pending"
          },
          {
            "facilityName": "Dameron Hospital Association",
            "amount": 29000000,
            "awardDate": "2024-01-02",
            "step1Modification": "Yes",
            "step2Modification": "No; may apply in future"
          },
          {
            "facilityName": "El Centro",
            "amount": 28000000,
            "awardDate": "2023-10-05",
            "step1Modification": "Yes",
            "step2Modification": "Yes"
          },
          {
            "facilityName": "St. Rose Hospital",
            "amount": 17650000,
            "awardDate": "2023-12-06",
            "step1Modification": "Yes",
            "step2Modification": "Pending"
          },
          {
            "facilityName": "Hazel Hawkins Memorial",
            "amount": 10000000,
            "awardDate": "2024-07-01",
            "step1Modification": "No",
            "step2Modification": "No; may apply in future"
          },
          {
            "facilityName": "John C Fremont",
            "amount": 9350000,
            "awardDate": "2024-01-17",
            "step1Modification": "Yes",
            "step2Modification": "No; may apply in future"
          },
          {
            "facilityName": "Kaweah Delta",
            "amount": 20750000,
            "awardDate": "2024-02-21",
            "step1Modification": "Yes",
            "step2Modification": "No; may apply in future"
          },
          {
            "facilityName": "Madera Community Hospital",
            "amount": 57000000,
            "awardDate": "2024-06-13",
            "step1Modification": "Yes",
            "step2Modification": "No; may apply in future"
          },
          {
            "facilityName": "Martin Luther King Jr.",
            "amount": 14000000,
            "awardDate": "2023-11-29",
            "step1Modification": "Yes",
            "step2Modification": "Yes"
          },
          {
            "facilityName": "Palo Verde Hospital",
            "amount": 8500000,
            "awardDate": "2023-11-21",
            "step1Modification": "Yes",
            "step2Modification": "Pending"
          },
          {
            "facilityName": "Pioneers Memorial Hospital",
            "amount": 28000000,
            "awardDate": "2023-10-30",
            "step1Modification": "Yes",
            "step2Modification": "No; may apply in future"
          },
          {
            "facilityName": "Ridgecrest Regional Hospital",
            "amount": 5500000,
            "awardDate": "2023-11-29",
            "step1Modification": "Yes",
            "step2Modification": "No; may apply in future"
          },
          {
            "facilityName": "San Gorgonio Memorial",
            "amount": 9800000,
            "awardDate": "2024-01-18",
            "step1Modification": "Yes",
            "step2Modification": "No; may apply in future"
          },
          {
            "facilityName": "Sonoma Valley Hospital",
            "amount": 3100000,
            "awardDate": "2024-07-11",
            "step1Modification": "Yes",
            "step2Modification": "No; may apply in future"
          },
          {
            "facilityName": "TriCity Medical Center",
            "amount": 33200000,
            "awardDate": "2023-11-29",
            "step1Modification": "Yes",
            "step2Modification": "Yes"
          },
          {
            "facilityName": "Watsonville Hospital",
            "amount": 8300000,
            "awardDate": "2023-10-30",
            "step1Modification": "Yes",
            "step2Modification": "Yes"
          }
        ],
        "awardCount": 16,
        "awardTotal": 292500000,
        "terms": "Zero-percent interest; repayable over 72 months with an initial 18-month grace period.",
        "caveat": "These are original loan-award amounts, not disbursement balances, repayments, forgiveness, or current net debt. The page's modification status can change and should be refreshed before publication."
      }
    },
    "hqafViiiRegistry": {
      "programPeriod": "Calendar years 2023 and 2024",
      "officialSource": "DHCS Hospital Quality Assurance Fee Program page",
      "sourceUrl": "https://www.dhcs.ca.gov/providers-partners/hospital-quality-assurance-fee-program-hqaf/",
      "parseStatus": "direct_model_file_listed_not_parsed",
      "caveat": "The DHCS HQAF page now lists the HQAF VIII Fee & Payment Model (CY 2023 and 2024) and inpatient/outpatient UPL workbooks as direct downloads. They are not yet parsed; no facility-level or aggregate HQAF model amounts are reported or inferred. Parsing is a scoped next step for the first draft.",
      "modelFileUrl": "https://www.dhcs.ca.gov/wp-content/uploads/2025/10/HQAF-VIII-Fee-Payment-Model-CY-2023-24.xlsx",
      "checkedOn": "2026-09-26"
    },
    "federalMediCalImpacts": {
      "bestOfficialSource": {
        "publisher": "California Department of Health Care Services",
        "title": "Medi-Cal Financing: Federal Policy Impacts",
        "url": "https://www.dhcs.ca.gov/federal-impacts/Pages/financing.aspx",
        "why": "DHCS owns California Medi-Cal implementation and currently states what is final, proposed, under analysis, and time-limited. It should control California implementation claims, while Congress and CMS control statutory and federal regulatory claims.",
        "boundary": "DHCS has not published a validated facility-by-facility net impact allocation."
      },
      "sourceHierarchy": [
        {
          "level": 1,
          "authority": "Enacted statute",
          "publisher": "U.S. Congress",
          "use": "What the law requires",
          "artifact": "Public Law 119-21"
        },
        {
          "level": 2,
          "authority": "Final and proposed federal implementation",
          "publisher": "CMS",
          "use": "Effective dates, transitions, grandfathering, and regulatory status",
          "artifact": "January 2026 final rule and May/July 2026 proposed rules"
        },
        {
          "level": 3,
          "authority": "California implementation and fiscal baseline",
          "publisher": "DHCS",
          "use": "California tax/payment status, official estimates, and state response",
          "artifact": "Medi-Cal Financing page and May 2026 Local Assistance Estimate"
        },
        {
          "level": 4,
          "authority": "Independent state fiscal analysis",
          "publisher": "California LAO",
          "use": "Budget uncertainty and scenario context",
          "artifact": "2026-27 Medi-Cal Fiscal Outlook"
        },
        {
          "level": 5,
          "authority": "CRWDHEALTH analytical scenario",
          "publisher": "CRWDHEALTH",
          "use": "Transparent exposure sensitivity only",
          "artifact": "federal_medi_cal_exposure.json"
        }
      ],
      "officialEvidence": [
        {
          "publisher": "U.S. Congress",
          "title": "Public Law 119-21",
          "url": "https://www.congress.gov/119/plaws/publ21/PLAW-119publ21.pdf",
          "finding": "Sections 71115 and 71116 establish provider-tax and state-directed-payment constraints used as the policy parameters in the exposure screen."
        },
        {
          "publisher": "U.S. Centers for Medicare & Medicaid Services",
          "title": "January 2026 health-care-related-tax final rule",
          "url": "https://www.cms.gov/newsroom/fact-sheets/preserving-medicaid-funding-vulnerable-populations-closing-health-care-related-tax-loophole-final",
          "finding": "CMS finalized the tax-loophole rule and a transition through calendar year 2026 for recently approved MCO taxes such as California's. This is final\u2014not a scenario."
        },
        {
          "publisher": "U.S. Centers for Medicare & Medicaid Services",
          "title": "May and July 2026 state-directed-payment and provider-tax proposed rules",
          "url": "https://www.cms.gov/newsroom/fact-sheets/amending-indirect-hold-harmless-threshold-health-care-related-taxes-proposed-rule-cms-2452-p",
          "finding": "CMS describes proposed implementation details for P.L. 119-21. Proposed provisions remain visibly distinguished from the January final rule."
        },
        {
          "publisher": "DHCS",
          "title": "Medi-Cal Financing: Federal Policy Impacts",
          "url": "https://www.dhcs.ca.gov/federal-impacts/Pages/financing.aspx",
          "finding": "DHCS states that California's current MCO tax remains intact through December 31, 2026, after which the same structure will no longer be federally approvable, and that it is analyzing implications for Proposition 35 and existing directed payments."
        },
        {
          "publisher": "California Legislative Analyst's Office",
          "title": "The 2026-27 Budget: Medi-Cal Fiscal Outlook",
          "url": "https://lao.ca.gov/Publications/Report/5092",
          "finding": "LAO identifies material uncertainty for the private hospital fee (HQAF) under federal policy changes and explains that its outlook is a fiscal projection, not a hospital-level impact allocation."
        }
      ],
      "externalEstimates": [
        {
          "publisher": "KFF",
          "status": "not incorporated",
          "caveat": "No KFF estimate is used in this artifact. If added later, it must be labeled an external estimate rather than California official evidence and paired with its source date and methodology."
        }
      ],
      "exposureScenario": {
        "status": "illustrative exposure screen, not a forecast or allocation of federal cuts",
        "baseline": {
          "year": 2024,
          "cohort": "299 comparable general acute hospitals",
          "mediCalNetPatientRevenue": 44304434123.0,
          "allPayerNetPatientRevenue": 146218842902.0,
          "mediCalPayerMixShare": 0.303001,
          "source": "HCAI HAFD broad-payer net patient revenue fields; fee-for-service and managed-care components combined."
        },
        "statewideSensitivity": {
          "1Percent": 443044341.23,
          "3Percent": 1329133023.69,
          "5Percent": 2215221706.15
        },
        "hqafFinancingCompressionScreen": {
          "formula": "FY 2026-27 HQAF revenue \u00d7 (1 - 3.5% / about 5%)",
          "hqafRevenue2026_27": 9853027000,
          "approximateCurrentTaxShare": 0.05,
          "ffy2032Ceiling": 0.035,
          "mechanicalCompressionShare": 0.3,
          "mechanicalAmount": 2955908100.0,
          "interpretation": "A constant-base financing-cap screen only. It is not a hospital payment loss, state budget forecast, net fiscal effect, or facility allocation."
        },
        "artifact": "federal_medi_cal_exposure.json"
      },
      "caveat": "The scenario is a payer-revenue sensitivity and financing-cap screen, not a facility forecast or allocation of federal cuts. It does not convert DHCS or LAO projections into hospital losses."
    },
    "cmsCareCompareRegistry": {
      "status": "implemented_public_metastore_resolved",
      "measureFamilies": [
        {
          "name": "HCAHPS / Patients' Perspectives of Care",
          "datasetId": "dgck-syfz",
          "officialLandingPage": "https://data.cms.gov/provider-data/topics/hospitals/hcahps-patients-perspectives-of-care",
          "selection": "Summary star rating and percent who definitely recommend."
        },
        {
          "name": "Timely and Effective Care",
          "datasetId": "yv7e-xc69",
          "officialLandingPage": "https://data.cms.gov/provider-data/topics/hospitals/timely-effective-care",
          "selection": "SEP-1 and OP-18b emergency-department median minutes."
        },
        {
          "name": "Readmissions",
          "datasetId": "9n3s-kdb3",
          "officialLandingPage": "https://data.cms.gov/provider-data/topics/hospitals/readmissions",
          "selection": "All available HRRP condition-specific excess readmission ratios and count above 1."
        },
        {
          "name": "HCAHPS National",
          "datasetId": "99ue-w85f",
          "officialLandingPage": "https://data.cms.gov/provider-data/dataset/99ue-w85f",
          "selection": "National comparison only when measure definition and reporting period exactly match."
        }
      ],
      "distributionResolution": "At fetch time, each distribution URL is resolved from https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/{id}; opaque resource URLs are not hard-coded.",
      "linkage": "Facilities are linked only with documented six-digit CMS Certification Numbers (CCNs); no name matching is used.",
      "caveat": "CMS releases can suppress or omit a measure. HRRP ratios are condition-specific and are not combined into a score; an excess-ratio count above 1 is descriptive only."
    },
    "limitation": "The Almanac reports official financing and program context plus transparent exposure sensitivities. It does not predict facility losses, state policy responses, enrollment or utilization changes, or net federal/state fiscal effects."
  }
}