Health care regulation in California: DMHC, OHCA, DHCS, and HCAI.
Agency decisions shape how policy works in practice. Explore the institutions and policy matters relevant to health care organizations, then discuss the proceedings affecting your business.
Who writes and enforces the rules.
- Department of Managed Health Care (DMHC)Licenses and regulates HMOs and most plans: network adequacy, timely access, grievances, AI in utilization review.
- Office of Health Care Affordability (OHCA) and the Health Care Affordability BoardSets and enforces the statewide cost growth target; performance improvement plans and penalties.
- Department of Health Care Services (DHCS)Medi-Cal, managed care contracting, rate-setting, and the MCO tax.
- Department of Health Care Access and Information (HCAI)Hospital financial data, cost transparency, distressed-hospital programs.
- Attorney General, health facilities reviewConsent to sales, transfers, and conversions of nonprofit hospitals and health facilities.
- Covered California and the Department of InsuranceExchange policy; PPO and insurance products outside DMHC.
Rulemakings, programs, and enforcement in 2026.
- OHCA cost targetRulemakingStatewide health care cost growth target. 3.5 percent annual growth target for 2025 and 2026, declining afterward; seven hospitals designated high-cost at 1.8 percent for 2026. 2025 was reporting only. Enforcement runs from technical assistance to public explanation, performance improvement plans, and financial penalties. Enforcement begins with the 2026 target year.
- DMHC enforcementEnforcementTimely-access and reporting penalties. December 2025 fines totaling $1.7 million against three Centene-owned plans for timely-access reporting failures, and a separate $15 million penalty against Anthem Blue Cross. Signals the 2026 posture.
- Proposition 35ProgramPermanent managed care organization tax. Funds targeted Medi-Cal rate increases. New structure from January 1, 2027 pending federal approval; roughly two million enrollees move from managed care to fee-for-service by that date. Live, deadline-driven.
Discuss your California
policy priorities.
Tell us what is changing for your organization.
We’ll discuss the representation and scope you need.