{
  "version": 1,
  "generatedAt": "2026-09-07T04:32:07.308636+00:00",
  "data": [
    {
      "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"
    }
  ]
}