Medi-Cal Member Reconciliation · Before January 1, 2027
The Patients your DPH manages in Epic.The Medi-Cal Members the MCP has assigned to your DPH roster.
FHG converts your MCP partner’s claims data into a Member-by-Member reconciliation asset for your DPH — every Member, every month. No EHR access required. This belongs on your monthly Hospital Board packet.
The DPH balance sheet sits on supplemental-payment-stream reimbursement — DSH · SNCP · CPE · GPP · QIP · EPP — that was never built for 6-month redetermination cadence. Build the skill and develop the muscle memory to manage these shifts at the COHS layer — before OBBBA Title VII doubles every gap on January 1, 2027. Eight Rolling-12 cycles to the cliff; four weeks to your first FHG baseline.
All Medi-Cal segments
Inside the oval: the 220,000 Patients in your DPH Epic. Outside-oval hatched: Medi-Cal Members the MCP assigned to your DPH roster, not yet seen in your Epic. Inner orange: Patients in your DPH Epic who are insured by the MCP — but assigned to a competitor DPH or community-provider roster, not yours.
What FHG sees · Natively bilingual
Patients your DPH manages that the MCP has assigned to your DPH roster. Medi-Cal Members the MCP has assigned to your DPH roster — that your clinicians have never seen. Patients your DPH manages today — that the MCP has assigned to a competitor DPH or community-provider roster instead.
Our clinicians deliver care to the MCP’s Medi-Cal Members every day; a competitor DPH gets credit because the MCP’s roster says our Patients belong to them.
— DPH Chief Financial Officer, observing the bidirectional reconciliation gap at the COHS layer
What FHG makes operational today
MCP mistakes FHG surfaces today
The Pond · Rolling 12
Total Member
Months
1,210,000
Rolling 12
Members
MEDS-eligible
165,047
Rolling 12
Members
with claims
95,073
Rolling 12
The denominator is bounded. The reconciliation is what makes it actionable at the COHS layer. Every Medi-Cal Member, every month — already operational today.After 1/1/27: every MEDS renewal cycle compresses to 26 weeks. The same Pond is reconciled twice a year, every supplemental-payment-stream eligibility verification stacks on top.
Population to track · PCP Panel Reconciliation
How does your DPH manage capitated risk when PMPM paid through your MCP partner flows through Medi-Cal Members the MCP has assigned to your DPH roster — but your clinicians have never seen? This belongs on your monthly Hospital Board packet.
↓ click any node to drill into Members
Source · Data Ingestion 1 — Medi-Cal Member ReconciliationToday: 53,000 Members at $870M PMPM, 100% unmanaged. After the storm: PCP continuity breaks faster through MEDS — the residual grows; the DSH/SNCP/CPE/GPP/QIP/EPP stack stresses at the same time.
Population to track · Geographic Reach
The coastal stretches, the Central Valley extent, the rural reaches of the service area. In-network on paper — on the COHS roster. Unreachable in practice. $32M in unmanaged PMPM — monthly tracking required for the supplemental-payment-stream-eligible Member pool.
↓ click any node to drill into Members
Level 1 · COHS Roster Denominator
FHG starts with every Medi-Cal Member who generated claims activity at the COHS layer in Rolling 12.
95,000 Members on this DPH-archetype demo — the active claims-side universe.
Level 2 · Claims-vs-MEDS Split
Split by whether MCP claims data shows a Member-resident address consistent with the DPH service area.
78,000 generated claims with addresses; 17,000 are on the COHS roster but produced no claims at all at the DPH layer.
Level 3 · Hours From Care
2,000 Medi-Cal Members in-state but hours from any in-network DPH PCP. In-network on the COHS roster, on paper. Unreachable in practice. $32M in unmanaged PMPM.
Today: a small but legible residual. After Jan 1, 2027: 6-month MEDS renewal notices land at addresses hours from any in-network DPH or community PCP — the residual doubles at the same time DHCS counts MEDS-verified eligibility for supplemental-payment-stream calculations.
Source · Data Ingestion 2 — Zip Code EligibilityToday: 2,000 Members at $32M PMPM. After the storm: doubled at the MEDS layer + supplemental-stream eligibility verification stress.
Roster to clean · Ineligible PCPs at the COHS layer
Long-departed from the DPH practice. Specialty-only NPIs not PCP-able under CalAIM PHM rules. NPIs that never billed under your DPH TaxID. Medi-Cal Members assigned to clinicians who can’t deliver care. FHG surfaces every one by name, NPI, activity, and PMPM.
↓ hover any row to see the narrative
Ineligible-Clinician mistake-type distribution · N = 207
| Clinician | NPI | Members | Activities | Total Charges | Specialty | Mistake reason |
|---|---|---|---|---|---|---|
| Prov 19021 | 1528063500 | 400 | 1,845 | $1,641,533 | Primary Care | Departed 2024 |
| Prov 3798 | 1104388644 | 104 | 612 | $985,233 | Cardiology | Not PCP-able |
| Prov 11240 | 1294560011 | 247 | 1,103 | $722,109 | Primary Care | Never at DPH TaxID |
| Prov 8821 | 1098765432 | 312 | 1,544 | $1,123,901 | Primary Care | Departed 2021 |
| Prov 22200 | 1609890250 | 879 | 3,859 | $1,489,071 | Family Med | Off-COHS 2023 |
Source · Data Ingestion 3 — Provider Database Reconciliation at the COHS layerHighlighted row narrated by client. Today: 207 ineligible clinicians on this DPH-archetype COHS roster. After the storm: the CalAIM PHM data-exchange cleanup cycle runs every six months instead of annually.
Cadence to track · Medi-Cal Member Volatility through MEDS
Adds. Drops. Net. FHG tracks every Medi-Cal Member transition through MEDS at the COHS layer, month over month — the kind of detail the supplemental-payment-stream reimbursement architecture was never built to absorb at 6-month cadence.
↓ hover any month for the numbers · flip Storm mode to see the cadence change
Source · Data Ingestion 1 — MEDS Eligibility History at the COHS layerToday: Nov / Dec MEDS-renewal outliers under annual-renewal cadence. After the storm: every 26-week cycle is an outlier; every supplemental-payment-stream eligibility verification stacks on top.
Convert your MCP partner’s claims data into your DPH’s asset.
Find your Patients. Track their Medi-Cal Members. Every month.
Talk with FHGSibling Use Cases
MCP understands its DPH network· MCP monitors MEDS renewal· DPH monitors MEDS renewal· ECM provider tracks Member ID / enrollment· Monthly Medi-Cal Member Reconciliation
Member-level drilldown
Level 1 · MEDS-Eligible Denominator
FHG starts with every Medi-Cal Member on MEDS eligibility in Rolling 12.
165,000 Members on this DPH-archetype demo — the reconciliation universe at the COHS layer.
Level 2 · PCP-Assignment Split
Split by whether the MCP put a PCP-of-record on the eligibility file.
118,000 have a PCP assigned; 47,000 do not — no clinical relationship anchor on the COHS roster at all.
Level 3 · 100% Unmanaged
53,000 Medi-Cal Members had a PCP-of-record assigned but never saw them. $870M in PMPM paid — 100% unmanaged. No clinical anchor in Epic.
Today: $870M in PMPM, out of sight. After Jan 1, 2027: 6-month MEDS renewal cycles break PCP continuity faster at the COHS layer — every renewal grows this column; every renewal stresses your DPH supplemental-payment-stream eligibility verification at the same time.