Considerations for Medicare Billing in Federally Qualified Health Centers

CHCF December 9, 2025
Wipfli Advisory

Key Takeaways

• Medicare patients, including those dually eligible for Medicare and Medi-Cal, are a growing population at California’s Federally Qualified Health Centers.
• Medicare pays health centers differently than Medi-Cal, and understanding these distinct payment rules is essential for health centers to be reimbursed correctly.
• The stronger Medicare billing practices outlined in this publication can help FQHCs’ financial sustainability.

Across California, many people seek care at Federally Qualified Health Centers, commonly known as FQHCs. As Californians continue to age, more Medicare patients are receiving care in FQHCs. These patients include those with both Medicare and Medi-Cal coverage (“dually eligible enrollees”) as well as those with Medicare only.

Since Medicare pays FQHCs differently than Medi-Cal, health centers that understand Medicare’s...

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