The California Medi-Cal program offers Tribes and Tribal programs a way to receive payments for many administrative activities they perform in providing healthcare to Medi-Cal enrollees. Many Tribes and Tribal organizations are already providing these activities, but are not being reimbursed for them. Examples of activities that may qualify for reimbursement include:
Conducting outreach to potential Medi-Cal enrollees, including at schools or clinics;
- Assisting with enrollment in Medi-Cal;
- Providing referral assistance to community providers;
- Providing transportation to medical appointments; and
- General administrative activities.
To qualify for reimbursement, the Tribe or Tribal organization will need to enter into an agreement with Medi-Cal that spells out the qualifying activities that it will perform, the applicable cost principles for determining reimbursement, and other matters. There are record keeping and reporting requirements for claiming the costs of these expenses.
Administrative costs for administering a Tribal health program can be significant, and Tribal health programs should consider participating in the administrative claiming program to offset the costs of operating their programs.