Key Takeaways
- Grow fee-for-service Medicare and value-based payment arrangements. California CHCs demonstrate wide variation in Medicare readiness — with gaps in billing practices, data infrastructure, and payer engagement leaving significant revenue unclaimed and limiting their ability to effectively serve and retain older adult patients.
- Optimize Medicare care delivery and clinical processes. Many California CHCs have an opportunity to improve data infrastructure and standardize workflows needed to effectively support older adult care, as high-performing health centers demonstrate that robust reporting systems and streamlined processes are key drivers of Medicare readiness.
- Better support health center staff. With 80% of CHCs planning to prioritize Medicare optimization in the next three years, investing in staff training and building foundational Medicare knowledge represents a high-impact opportunity to lay the groundwork for long-term financial sustainability and better care for older adults.
As nearly 10 million Californians are projected to be 65 and older by 2030, community health centers (CHCs) face mounting pressure to adapt their care delivery, operations, and billing practices to effectively serve a growing Medicare-eligible population.
California’s Medicare landscape is also growing more complex, with the rollout of Dual Eligible Special Needs Plans, expanding Medicare Advantage enrollment, and ongoing federal threats to Medi-Cal funding placing new operational and financial demands on CHCs — often without the infrastructure needed to meet them.
Drawing on surveys and interviews with 24 California CHCs, this issue brief identifies critical gaps in Medicare readiness — including inconsistent billing practices, limited use of data for payer engagement, and insufficient staff training — that threaten both the financial sustainability and care quality of these essential safety-net providers. The brief offers actionable strategies to help CHCs strengthen care management, optimize data infrastructure, standardize workflows, and build the Medicare expertise needed to retain older adult patients and thrive in an increasingly complex health care landscape.
