Medi-Cal Managed Care Protections for Indian Health Care Providers

The California Department of Health Care Services (DHCS) in Feb. 2024 issued comprehensive guidance to assist Medi-Cal managed care plans (MCOs) in meeting their federal and state law obligations to Native American enrollees and to Indian health care providers that operate under 638 ISDA agreements. Among the topics the guidance addresses are Native Americans’ access rights to tribal health care providers, including out-of-network providers, and prohibitions on imposing cost-sharing and similar fees on Native American enrollees. MCO cannot require tribal health care providers to obtain professional liability insurance, to provide indemnification, or to submit disputes to binding arbitration. Finally, DHCS is requiring each MCO to appoint a tribal liaison dedicated to working with contracted and non-contracted tribal health care providers in their service areas.

There are other requirements in the guidance with respect to payments to, and credentialing of, tribal health care providers.