HQAFHeadquarters, Department of the Air Force (US)
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With Medicaid currently representing approximately 41% of gross revenues and 32% of net revenues, LLUMC is a major beneficiary of California's HQAF program.
Fitch recognizes the importance of the benefit from the HQAF program on LLUMC's margins, although LLUMC's high exposure to Medicaid and supplemental payment volatility is considered a general revenue constraint.
As discussed above, fiscal 2018 has been an HQAF catch-up year as LLUMC accrued net program benefits covering multiple years after not recording HQAF revenue in the six-month fiscal year 2017.
The lower revenue growth assumption of -2.4% in 2019 from the annualized 2018 level reflects Fitch's expectations that HQAF revenues will not include any prior-year accruals in 2019.
The Centers for Medicare and Medicaid Services (CMS) approved Phase 5 of the HQAF program in late 2017 (for the period January 2017 to December 2019).
Due to CMS' delay in approving the fee-for-service component, LLUMC did not record any HQAF revenues in the six-month audit ending June 30, 2017.
Overall, LLUMC recorded HQAF increased revenue (fee for service portion) of $143.5 million for the six months ended Dec.
2016) if the current phase of the HQAF program would have been approved and recognized.