CA AB186

Renames the "Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act Program" to the "Medi-Cal Physicians and Dentists Loan Repayment Program" and establishes the Medi-Cal Loan Repayment Program Special Fund, continuously appropriated and funded by transfers from the California Electronic Cigarette Excise Tax Fund, managed care plan remittances, and other appropriations.

Requires skilled nursing facilities to spend at least 85% of COVID-19 emergency Medicaid payments on additional labor costs (wages, benefits, bonuses, overtime); facilities failing to meet this threshold must remit the difference to the department.

Extends the Medi-Cal Long-Term Care Reimbursement Act through December 31, 2026 (repeals January 1, 2028) and establishes annual rate increases for 2023-2026 ranging from 1-5% depending on cost category and facility workforce standards.

Creates the Workforce and Quality Incentive Program allowing skilled nursing facilities in Medi-Cal managed care to earn performance-based directed payments (targeting $280 million in 2023) based on workforce and quality metrics, with annual increases through 2026.

Redirects medical loss ratio remittances from Medi-Cal managed care plans (previously going to physician loan repayment) to the new Medi-Cal Loan Repayment Program Special Fund for both physicians and dentists.