It also left a litany of unanswered questions: who came up with the narrow criteria, how many hospitals would qualify and whether the funding will be enough to prevent hospital closures in the near term.

Assembly Bill 108, signed into law last week, will provide grants to public and nonprofit hospitals that meet several criteria, including having less than 10 days of cash on hand and having more than half of their patients on government-funded insurance programs or uninsured. The goal is to tide eligible hospitals over until July 1, when the new fiscal year begins, said Sen. John Laird, a Santa Cruz Democrat who chairs the Senate Budget Committee and championed the funding bill.

The measure, put in print on May 4, flew through both legislative chambers in just three days before Gov. Gavin Newsom signed it within hours. By Monday, the program was up and running and hospitals had just a week to apply. The Department of Health Care Access and Information will announce recipients May 26.

“It is a rare occurrence for bills to go from the starting block to the finish line in just a few days,” said veteran lobbyist and Capitol watcher Chris Micheli, who said the speed reflects the urgent need of hospitals and a consensus among leaders.

Hospital leaders interested in applying said they were pleased the Legislature acted so quickly, though some are scrambling to meet the application deadline after learning about it just a week ago.

Laird told CalMatters that he knows of two to three hospitals that will likely qualify but declined to name them, arguing that doing so could scare off vendors and hospital staff.

When pressed, he acknowledged that potential recipients include Watsonville Community Hospital in his own district.

“This bill comes at a completely inopportune time in the budget process, and the time was not dictated by us,” Laird said during a budget hearing last Tuesday. “It was dictated by a few hospitals going under.”

The criteria are so narrow and the bill moved in such an “expedited fashion” that it seems tailored to the needs of a specific hospital, said Assembly Budget Committee Vice Chair David Tangipa, a Fresno Republican, who voted for the bill nonetheless.

“It says 10 days. Why not put it at 30 days?” he said. “They needed to make sure that even though it appears to be a general fund that all of these other hospitals could apply for, that probably only one hospital met all of those qualifications.”

Neither Laird nor the finance department staff was able to explain how they came up with the criteria, including why they picked 10 days — instead of any other number — of cash on hand to indicate a dire enough financial situation. Hospital administrators said the typical goal is at least 90 days of cash on hand.

The ambiguity frustrated some state lawmakers, who repeatedly pressed for clarity during the budget hearing. Sen. Chris Cabaldon, a Napa Democrat, called the lack of answers “profoundly disturbing.”

“It’s been one long ‘I said what I said’ hearing,” he said. Still, he voted for it.

Others lamented that the criteria, especially the 10-day threshold, should have been expanded to allow more hospitals to compete for the funding.

“Right now, it’s far too narrow, and really by this time the hospital has gone over the cliff,” Sen. Lola Smallwood-Cuevas, a Los Angeles Democrat, told CalMatters in an interview. She, too, voted for it. “We want to figure out who’s standing on the cliff, who’s a few feet from the cliffs, who’s a mile from the cliff.”

The $25 million grant comes as hospitals across California, particularly in rural areas, say they are at risk of dropping services or shutting their doors due to rising labor costs and federal Medi-Cal funding cuts.

The funding woes sparked calls for renewed funding for the state’s Distressed Hospital Loan Program, which in 2023 gave 16 financially distressed hospitals nearly $300 million. Of those, 15 have asked for more time to repay the debt, and nine of them have also applied for loan forgiveness, according to the California Health Facilities Financing Authority.

The California Hospital Association, which represents nearly 400 hospitals, is sponsoring a bill to put another $300 million into the loan program. Senate Democrats proposed $200 million in funding in mid-April but have not specified if the dollars would be a loan or a grant.

Newsom proposed up to $50 million toward hospitals in “immediate and significant financial distress” in 2026-27 in his budget revision Thursday.

A few hospitals plan to apply

Watsonville Community Hospital, which has publicly shared its financial struggles, reported having 8 days of cash on hand in the last quarter of 2025, according to the most recent financial records collected by the state. The hospital received an $8.3 million state loan in 2023 as part of the distressed hospital program lawmakers passed that year. When asked about the hospital, Laird said the hospital is “quite likely” to be eligible.

“This is critically important for the hospital as we navigate fiscal challenges brought on by funding delays and cutbacks at the federal level,” hospital spokesperson Jennifer Murray said in an email.

Hospitals in the Central Valley and rural Southern California also could benefit from the grant, according to Laird.

Madera Community Hospital told CalMatters it intends to apply for a slice of the grant money. The hospital reopened its doors in March 2025 after closing at the start of 2023. American Advanced Management, the company that took over the hospital, received $57 million from the state to reopen it. State data show the hospital ended 2025 with two days of cash on hand.

Delays in reimbursements and low patient volume in its outpatient clinics are contributing to Madera Community’s slower-than-expected recovery, said Matthew Beehler, a spokesperson for the hospital. He said Madera Community is still working on contracting with some insurers and is not yet receiving funds from the Hospital Quality Assurance Fee, a state-federal supplemental payment program for hospitals that serve a high number of Medi-Cal and uninsured patients. State data show that in 2022, before the hospital closed, it relied on more than $16 million in supplemental payments.

The $57 million from the state, Beehler said, helped cover the hospital’s first six months of operations. Beyond that, American Advanced Management has covered the shortfalls.

“I think that we are headed towards the path of real sustainability for the hospital,” Beehler said. “It just takes time to have all that sort of reach its state of equilibrium.”

In the Eastern Sierra, Dr. Kevin Flanigan, CEO of the Southern Inyo Healthcare District, said he, too, plans to apply for the state’s emergency grant. He said his hospital needs about $1 million to get through 2026. However, he does not know if his hospital will qualify given the 10 days of cash on hand criteria. He said Southern Inyo’s cash balance fluctuates anywhere between 18 to 20 days of cash to 8 to 10 days — grim in either case.

If his hospital doesn’t qualify for a grant? “Then God willing, we find money elsewhere. If not, we begin the process of closing certain things,” Flanigan said. Southern Inyo is a small hospital, with only four acute care beds, 30 skilled nursing beds and an outpatient clinic; there isn’t much to cut from, he said.

“We are clearly one of the most precarious hospitals in the state.”

Unanswered questions

Laird told CalMatters he is confident the $25 million will be enough to save hospitals facing the most imminent threat of closure.

But it’s unclear how he and the finance department arrived at the dollar amount. Department of Finance spokesperson H.D. Palmer said the figure represents the administration’s “best assessment of potential funding needs” and is partly based on the Distressed Hospital Loan Program, which gave 16 hospitals an average of $19 million each to keep them afloat for several years.

Laird said the amount was based on the number of hospitals legislators “informally” think would be eligible. Whatever is left untapped by June 30 would revert back to the state, he said, and legislators could add more funding if it runs out.

“It is what we think is necessary now,” Laird said.

The Department of Health Care Access and Information collects and publishes financial data from hospitals quarterly, but that data lags. Which hospitals qualify for the grant will depend largely on their self-reported finances as of April 15, the department said.

Many state lawmakers want more answers, too. Sen. Shannon Grove, a Bakersfield Republican, grilled finance department staff over the bill details.

“How long is this lifeline going to last? Is it even going to save the people who are in the 10-day timeframe?” she asked.

“That is the intent,” said Lupe Manriquez of the Department of Finance.

“I know it’s the intent. Is it going to save them?” Grove pressed.

“That’s the goal,” Manriquez answered.

Cabaldon told the staff he wouldn’t even bother asking about the criteria because “I already know what the answer is going to be.”

“It is incumbent on this committee to be able to have real answers to the questions that are posed about the why and the evidence,” Cabaldon said. “We are not having a conversation. We are asking questions of fulfilling our constitutional role in this process and getting zero answers.”

Palmer called the heat on his staff “undignified sniping and sarcasm,” noting that the bill originated from the same legislative chamber that’s now questioning it.

“They asked for our assistance in the expedited consideration of the bill outside of the regular budget process — and we complied and cooperated,” Palmer said in an email. “If members were either unable or unwilling to do some basic homework on their own bill that they wanted to be put on a fast track, then that’s a question that’s better posed to them — not us.”

How long a lifeline?

But throwing money at hospitals to keep them afloat is not the answer, some lawmakers argued.

“We can’t just keep giving $25 million handouts over 10 days where a hospital is looking to close,” Smallwood-Cuevas said, noting that President Donald Trump’s H.R. 1, which sharply reduces federal spending on Medicaid, could devastate hospitals.

“What is the state doing to identify and support vulnerable safety net hospitals before they reach the point of fiscal crisis? That is an answer I want to hear.”

Some hospital administrators also called for longer-term solutions. Katherine Burnworth, board president of the Imperial Valley Healthcare District, which oversees Imperial County’s two hospitals, told CalMatters that while she appreciates state action, $25 million statewide “is a drop in the bucket compared to the scale of the problem.”

“That may help a small number of hospitals avoid a near-term emergency, but it does not address the ongoing instability that communities like ours live with year after year,” Burnworth said.

While acknowledging the importance of emergency grants, Republicans on the committee argued that California has shortchanged hospitals’ Medi-Cal reimbursements. The California Hospital Association estimates that hospitals are reimbursed 74 cents for each dollar they spend on Medi-Cal patients. Hospitals that see a high share of Medi-Cal patients do get supplemental payments to help offset some of the gaps in reimbursement.

The GOP lawmakers also said that some state regulations, such as a minimum wage hike for health care workers and the requirement that all hospitals comply with new seismic safety requirements by 2030, will burden hospitals with high costs.

“We are throwing Band-Aids on everything, when really we need to just get together and fix the issues of what are the unfunded state mandates that are on our hospitals right now,” Tangipa said.

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“End-of-life care is a difficult process for families to endure, and patients should be able to trust that their hospice providers are acting in good faith,” said Attorney General Bonta. “The crimes allegedly committed by the defendants against their patients, Medicare, and our state’s Medi-Cal program will not be tolerated. My office is committed to protecting the well-being of Californians and prosecuting those who abuse the financial integrity of our healthcare system.”

An investigation led by the California Department of Justice and assisted by the U.S. Department of Health and Human Services Office of the Inspector General and the California Employment Development Department revealed that from 2015 to 2021, the defendants allegedly billed Medicare and Medi-Cal for millions of dollars, fraudulently claiming that they were providing hospice care to patients who had less than six months to live when in fact these patients were not terminally ill. Each of the defendants allegedly played a role in the scam, which consisted of: paying illegal kickbacks to recruit patients for hospice care, including patients who did not qualify for hospice because they were not terminally ill; taking patient identity information and using it to put them in hospice without their knowledge; falsely representing to patients what services they would be receiving; and billing patients with one company, only to switch them to the other company in order to avoid detection.

When a patient is enrolled in hospice care, they give up their opportunity under the Medicare and Medi-Cal programs to receive medical treatment to prolong their life, such as chemotherapy for cancer patients. As a result of the defendants’ alleged actions, numerous ineligible patients were incorrectly certified as terminally ill and tricked into receiving hospice services, which would have made access to potentially lifesaving medical care difficult in the event that any of them required it.

The case was investigated by the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse (DMFEA). Through DMFEA, the Department of Justice works to protect Californians by investigating and prosecuting those who perpetrate fraud on the Medi-Cal program. DMFEA also investigates and prosecutes those responsible for abuse, neglect, and fraud committed against elderly and dependent adults in state licensed facilities. DMFEA regularly works with whistleblowers, the California Department of Health Care Services, and state and federal law enforcement agencies to investigate and prosecute Medi-Cal provider fraud and elder abuse, and fraud by entities other than Medi-Cal providers when their actions result in fraudulent claims. To learn more about DMFEA or to report Medi-Care fraud or elder abuse visit oag.ca.gov/dmfea.

It is important to note that a criminal complaint contains charges that must be proven in a court of law. Every defendant is presumed innocent unless or until proven guilty.

Office of the Attorney General California Department of Justice

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IE Business D. | Contributed

A medical/commercial complex in Hemet has been sold for $5.5 million.

Courtyard Medical & Professional Center at 910-960 N. State. St. was purchased by an out-of-country investor whose name was not released, Progressive Real Estate Partners in Rancho Cucamonga announced today.

The seller was a Newport Beach investor who also wished to remain anonymous. Progressive Real Estate represented both parties.

Built in 1981, the center covers nearly 40,000 square feet and is next to a Riverside County courthouse. It’s fully occupied and has 14 service-oriented tenants, including a law office, paralegal and DNA collections office.

The center is at the intersection of State Street and Fruitvale Avenue, which accommodates more than 20,400 vehicles a day. Thirteen qualified offers were made on the project, a sign that investors are willing to get into the Inland Empire’s second and third-tier markets, according to Progressive Real Estate.

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The health care trailer bill, AB 133, makes bold changes toward a more equitable and prevention-focused approach to health care through expanded behavioral health initiatives supporting California youth and people with severe behavioral health challenges, including those experiencing homelessness; extending Medi-Cal eligibility for postpartum individuals; supporting continued telehealth flexibilities; and advancing the state’s innovative CalAIM initiative.

“We’re investing California’s historic surplus to accomplish transformative changes we’ve long dreamed of – including this historic Medi-Cal expansion to ensure thousands of older undocumented Californians, many of whom have been serving on the front lines of the pandemic, can access critical health care services,” said Governor Newsom. “I thank the Legislature for its steadfast partnership to bring California closer to universal health care coverage and advance comprehensive initiatives to ensure California’s communities come back from the pandemic stronger and healthier than before.”

Under AB 133, approximately 235,000 Californians aged 50 years and older are newly eligible for Medi-Cal, including preventive services, long-term care and In-Home Supportive Services. In 2019, California became the first state to extend Medi-Cal coverage to all eligible undocumented young adults up to the age of 26 and with today’s expansion, the state has the most inclusive health coverage for low-income persons in the country. AB 133 also extends the Medi-Cal postpartum care period from 60 days to 12 months without requiring a mental health diagnosis, including for eligible undocumented Californians.

Governor Newsom signed the legislation at a Clinica Sierra Vista location in Fresno administering COVID-19 vaccinations to residents, in addition to serving the community’s primary medical, dental and behavioral health needs.

During his visit, the Governor highlighted the state’s multi-pronged strategy to reach communities with low vaccination rates and the first-in-the-nation measures announced yesterday to require all state workers and workers in health care and high-risk congregate settings to either show proof of full vaccination or be tested at least once per week. Local governments and businesses are encouraged to adopt similar measures amid the growing threat of the Delta variant.

Changing the life trajectory of children and youth in California, the health care trailer bill creates a prevention-focused behavioral health system in which all Californians age 25 and younger are supported and routinely screened for emerging and existing behavioral health needs – enabling them to grow up healthier, both physically and mentally. The initiative includes the creation of a statewide portal to connect young people with telehealth visits.

AB 133 implements an important component of the California Comeback Plan’s $12 billion homelessness package, creating the Behavioral Health Continuum Infrastructure Program at the Department of Health Care Services (DHCS) to expand treatment and housing options for all Californians, including people experiencing homelessness who struggle with the most acute behavioral health needs. AB 133 implements the Plan’s $2.2 billion investment for DHCS to provide competitive grants to local governments to construct, acquire and rehabilitate real estate assets or to invest in mobile crisis infrastructure to expand the community continuum of behavioral health treatment resources. The Plan’s total investments in this space constitute the biggest expansion in decades for clinically enhanced behavioral health housing.

In addition, AB 133 advances the state’s CalAIM initiative, a major transformation of the delivery of Medi-Cal to better manage risk and improve outcomes through whole person care approaches and addressing social determinants of health, and extends telehealth flexibilities allowed during the pandemic through December 2022, including payment parity for services delivered through audio-only modalities.

For full text of the bill, visit: http://leginfo.legislature.ca.gov.

gov.ca.gov | Contributed

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In recent days, several tweets shared ominous news about the state of health insurance in the country. One tweeter said she bought an Affordable Care Act policy for a $1,200 monthly premium and a $7,500 deductible. By May, she said, she could no longer afford that premium. 

Another tweeter said her 59-year-old friend would be paying $900 a month in premiums with an out-of-pocket maximum of $8,150. The friend has assets, but the insurance restricts where she can get care, a common policy feature.

A third tweeter was disgusted with his job-based coverage, which he told the world was his fifth insurance plan in four years. That’s not an uncommon complaint among workers with employer-based coverage. The man’s daughter has Type 1 diabetes, and the constant switching of doctors and plans was disruptive and hardly optimum for her health. It’s time to disconnect health insurance from the job, he tweeted.

The tweeters were fed up with the price of coverage and were having trouble either paying for it or accessing care. Millions are in the same pickle. At the crux of their dilemma is the relentless rise in medical prices along with America’s inability or unwillingness to provide health care to all its citizens and to establish a mechanism that can finally put the brakes on relentless price increases.

As Americans grow more dissatisfied with their insurance arrangements, public discussion about the wisdom of switching to a system sometimes referred to as Medicare for All has grown. There’s more press attention to this topic than I have ever seen. What’s not been discussed, however, is how providing health care for everyone and controlling prices are interrelated.

New U.S. spending data show that the U.S. spent $1 trillion more on personal health services in 2018 than in 2008. Hospital care accounted for 44 percent of the increase, physician services 23 percent and retail prescription drugs only 9 percent. With increases like those, dissatisfaction is bound to increase.

But in the current discussion of Medicare for All, which a few columnists are beginning to say should be put aside – one New York Times columnist argued that the moral and political case is now stronger for focusing on issues other than health care – the discussion has focused on why such a change won’t work: how it will harm the big stakeholders; how much it would cost; and that Americans are satisfied with their current arrangements.

It is the fear of controls on prices, which other advanced countries have, that has kept the U.S. from changing its system for decades. If every American were in the system, including the 30 million who have no health insurance, it might make it easier for federal regulators to control prices, which is what big stakeholders fear. It is the primary reason the idea of Medicare for All, or an equivalent plan, has never advanced very far.

(Making Health Care Accessible)

There’s another question that must be tackled before we can reach the point of providing coverage for everyone: Should America provide health insurance for every citizen?

The concept of solidarity – which loosely means a unity based on a community of interests, objectives, or standards – is the basis for the health systems in most European countries. It also undergirds our own Social Security retirement and disability programs, workers’ compensation, and, of course, Medicare. 

When it comes to health care, there is still no universal embrace of the concept of solidarity. But unless Americans agree that every citizen is entitled to medical care and a way to pay for it, this round of discussion about Medicare for All is as likely to fail as all the previous proposals.

But what about Obamacare, you might be thinking? Remember when the former president told us his health plan would bring “affordable, quality care for all”? The Affordable Care Act established the principle that everyone should be able to buy health insurance regardless of preexisting health conditions, but it did not take the further step of guaranteeing everyone the right to medical care and a way to pay for it.

“Winning the argument about universal coverage first is really important,” says Joel Kutzin who heads the health care financing team at the World Health Organization.

It’s the prerequisite to solving the insurance cost and service problems the three unhappy tweeters shared with the twitterverse. 

Should every American have the right to affordable health care? Write to Trudy at trudy.lieberman@gmail.com.

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From private companies to public, there are numerous ones out there to look at and consider.  Investment managers have built portfolios of cannabis companies that are stated to expand diversification and reduce risks.  Sectors of the economy expanding into Cannabis include medical, food and beverage, tobacco, security, transportation, processing, automation, real estate, chemical and fertilizer, and manufacturing. A new world has opened up and embraced Cannabis as a multi-billion-dollar industry to start. 

An investor can directly invest in a cannabis company that cultivates, manufactures, and sells its wares.  Another option is to indirectly invest in the industry through companies that support cannabis producers.  Mentioned earlier, this could be new plastic bags, or the RFID used to track-and-trace that states require.  There is a hub of businesses that are in the business but not in the business.  When building a position or selecting a company to invest in it is important to understand that you may already have exposure through an existing position.  For example, Constellation Brands (STZ), an alcohol company with operations worldwide that produces brands like Corona, Modelo, and Ballast Point, is in the business.  Constellation owns 38% of Canopy Growth, a Canadian Pot Producer.  The same is true for many companies.  It is hard for them not to push into a new high growth area.  After all there are two congressional bills moving through the Hill right now to allow cannabis companies to bank with FDIC institutions and to move it from a Class 1 to a Class 3 drug.  With the illegal becoming legal, a new opportunity has arisen and isn’t likely to go up in smoke.

Take GW Pharmaceuticals (GWPH), a British company known for its multiple sclerosis treatment product Nabiximols, which was the first natural cannabis plant derivative to gain market approval in every country, even ours.  Their latest drug treats pediatric seizures.  Breakthroughs are happening in every facet.   The key is to not jump into any company before you understand what you are buying their price movements. 

Concerns about the cost of cannabis and related products and where it is headed is a risk.  The cost will most likely be driven down and so may be margins as larger producers and market efficiencies occur.  This will force consolidations in the industry and sharp barriers to entry too.  What I have noticed is there is substantial volatility in pricing of these companies.  By being patient, you can pick up what you wish to buy on the dip and you shouldn’t have to wait long to get the opportunity. 

Pot’s passé and Cannabis is open for business.

Andrew F. Kotyuk, CIMA* is CEO and Principal of Alpha Wealth Management LLC

For questions or investment topics, please email me afkotyuk@alpha-wealth.com.

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