California Medicaid Plans Withhold Hospice Room-and-Board Payments
California hospices report that some Medi-Cal managed care plans continue to delay or deny pass-through room-and-board reimbursements owed for dual-eligible nursing home residents, despite state law barring prior authorization requirements for these payments. A CHAPCA survey of 18 members found roughly $4.57 million in outstanding payments, some dating to 2023, while YoloCares alone says it is owed more than $300,000 and is weighing legal action. California's Department of Managed Health Care previously issued guidance directing plans on proper handling of these payments, but providers say compliance remains inconsistent. Stakeholders are now calling on the state to intervene further, and providers warn that unreimbursed pass-through payments could expose hospices to federal inducement scrutiny.