Docusign Envelope ID: 53BA75AD-2403-4263-86FB-389131D03DCA DHCS
CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES
Michelle Baass | Director
October 3, 2025
Eric McCoy
Fire Chief
City of Huntington Beach
2000 Main Street
Huntington Beach, CA 92648
Dear Eric McCoy:
The Department of Health Care Services (DHCS) has completed its calculation of the following:
1. Rating Period CY 2024 Voluntary Rate Range Program (service period of January 1, 2024, through December 31, 2024) payment transfer amounts for the Intergovernmental Agreement Regarding Transfer of Public Funds (Agreement), No.
IGT-24-0013. As stated in Section 1.3 of the Agreement, the enrollment reconciliations will occur on an ongoing basis as updated enrollment figures become available. Actual enrollment will not be considered final until two years after December 31, 2024.
2. Rating Period CY 2023 Voluntary Rate Range Program (service period of January 1, 2023, through December 31, 2023) payment transfer amounts for the reconciliation to Intergovernmental Agreement Regarding Transfer of Public Funds (Agreement), No. IGT-23-0008. As stated in Section 1.3 of the Agreement, the enrollment reconciliations will occur on an ongoing basis as updated enrollment figures become available. Actual enrollment will not be considered final until two years after December 31, 2023.
Based on the above calculations, and as provided in the above referenced Agreements, DHCS is requesting that City of Huntington Beach transfer funds in the amount of $722,804 to DHCS by no later than Friday, November 21, 2025. Detailed invoices are attached to the email communications. Please transfer the above Total Amount to the following:
California Department of Health Care Services State of California Capitated Rates Development Division Gavin Newsom, Governor 1501 Capitol Avenue, P.O. Box 997413
Sacramento, CA, 95899-7413
MS 4413 | Phone (916) 345-7070 | Fax (916) 650-6860
https://www.dhcs.ca.gov/ California Health and Human Services Agency Docusign Envelope ID: 53BA75AD-2403-4263-86FB-389131D03DCA New Bank Information:
U.S. Bank
1 California Street, Suite 100
San Francisco, CA 94111
For Credit: Department of Health Care Services
Account Number:
Routing Number:
For Further Credit to: Department of Health Care Services Reference: CY 2024 Voluntary Rate Range Program Invoice We require Governmental Funding Entity provide a 48-hour advance notice via e-mail prior to wiring any funds over 5 million dollars. As requested by the State Treasurer's Office (STO), all ACH/wires must be transmitted prior to 10:00 a.m. on the date of payment. Please note: DHCS would prefer Automated Clearing House (ACH) payments, instead of wires. Once the Governmental Funding Entity has transferred funds to the specified account above, please email Vivian Beeck at [email protected]; and Scott Gale at [email protected] with the completed transaction information.
If you have any questions regarding the Intergovernmental Transfer Agreement, please contact Vivian Beeck via email shown above.
Sincerely,
-DocuSigned by:
Michael Jordan
641B9785907E40F
Michael Jordan
Staff Services Manager III
Capitated Rates Development Division
Department of Health Care Services
P.O. Box 997413, MS 4413
Sacramento, CA 95899-7413
Enclosures
CC: Vivian Beeck
Staff Services Manager I
Capitated Rates Development Division
Department of Health Care Services
P.O. Box 997413, MS 4413
Sacramento, CA 95899-7413
City of Huntington Beach
Agreement: IGT-24-0013
Contribution Estimated
Health Plan Rating Region Category of Aid SIS/UIS PMPM Estimant Member Contribution (Non- Federal Share)
CalOptima Orange Child SIS 0.04 123,767
CalOptima Orange Child LUIS
CalOptima Orange Adult 60,120
CalOptima Orange Adult 0.06 36,732
CalOptima Orange Adult Expansion 0.02 65,310
CalOptima Orange Adult Expansion 0.01 7.416
CalOptima Orange SPD 0.27 109,543
CalOptima Orange SPD UIS 0.17 19,543
CalOptima Orange SPD Dual SIS 0.10 124,463
CalOptima Orange SPD Dual LUIS 330
CalOptima Orange LTC SIS 534
CalOptima Orange LTC UIS 241
CalOptima Orange LTC Dual SIS 2,956
CalOptima Orange LTC Dual
CalOptima Orange WCM SIS 38,266
CalOptima Orange WCM LUIS 494
CalOptima Orange Est. FE Total 609,724
Total CY 2024 (January 2024 - December 2024) Section 1 Amount $ 609,724 CY 2024 (January 2024 - December 2024) Section 3 Amount under the Agreement:
Total CY 2024 (January 2024-December 2024) Section 1 Amount (above) $ 609,724 Less amount not subject to fee (Section 3.2) $
Basis for 20% Assessment Fee $ 609,724
20% Assessment Fee (Basis * 20%) $ 121,945
Total CY 2024 Amount (January 2024 - December 2024) as of 09/2025 Estimated Member Months $ 731,669 Balance remaining from CY 2023 January 2023 - December 2023 (+/-) $ (8,865) Total Payment Transfer Amount $ 722,804