​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Memorand​a of Understanding​​​​ Between Medi-Cal Managed Care Plans and Third Party Entities ​

Return to the Managed Care All Plan Letters Homepage​​

Medi-Cal Managed Care Plans (MCPs) Contract with the Department of Health Care Services (DHCS) to provide high-quality, accessible, and cost-effective health care through managed care delivery systems. The MCP Contract requires MCPs to build partnerships with the following Third-​Party Entities ​to ensure Member care is coordinated and Members have access to community-based resources in order to support whole-person care​: 

​Local Health Departments; 

​Local educational and governmental agencies, such as county behavioral health departments for Specialty Mental Health Care and Substance Use Disorder (SUD) Treatment Services; and

Other local programs and services, including 

• Social services; 
• Child Welfare Departments; 
• Continuums of Care programs; 
• First 5 programs and providers; ​​​​​​​
• Regional Centers; 
• Area Agencies on Aging; 
• Caregiver Resource Centers; 
• Women, Infants, and Children Supplemental Nutrition Programs;
• Home and Community-Based Services (HCBS) waiver agencies and providers; and 
• Justice departments 

The Memoranda of Understanding (MOUs) requirements can be found in the MCP Contract, Exhibit A, Attachment III, Section 5.6 (MOUs with Third Parties). The MOUs are intended to be effective tools to clarify roles and responsibilities between MCPs and Third Parties, support local engagement, and facilitate care coordination and the exchange of information necessary to enable care coordination and improve the referral processes between MCPs and Third-Party Entities. The MOUs are also intended to improve transparency and accountability by setting forth certain existing requirements for each party as they relate to service or care delivery and coordination so that the parties to the MOU are aware of each other’s obligations.​

The purpose of the MOU is to:​​​​

• ​List the minimum MOU components required by the MCP Contract;
• Clarify roles and responsibilities for coordination of the delivery of care and services of all Members, particularly across MCP carved out services, which may be provided by the Third-Party Entity; ​
• Establish negotiated and agreed upon processes for how MCPs and Third-Party Entities will collaborate and coordinate on population health and/or other programs and initiatives;
  
• Memorialize what data will be shared between MCPs and Third-Party Entities and how the data will be shared to support care coordination and enable monitoring;
  
• Provide public transparency into relationships and roles/responsibilities between MCPs and Third-Party Entities; and
  
• Provide mechanisms for the parties to resolve disputes and ensure overall oversight and accountability under the MOU.​
  

MCP Contracts require MCPs to execute a MOU with each of the Third-Party Entities outlined below. DHCS has developed MOU Templates for MCPs and Third-Party Entities to utilize in this process to ensure that all MCP Contract provisions for MOUs are captured and provide standardization in reporting. Each MOU is a binding, contractual agreement between the MCP and a Third-Party Entity which outlines the responsibilities and obligations of the MCP and a Third-Party Entity to coordinate and facilitate whole-system, person-centered care for Members.​

The Base MOU Template is meant to provide context for the Bespoke MOUs. It includes each of the elements required to be included in all MOUs as set forth in the 2024 MCP Model Contract. The Base MOU Template includes the minimum requirements; MCPs and Third-Party Entities may include additional provisions so long as they do not conflict with the minimum required provisions. 

​​MOUs Effective January 1, 2024​

*MCPs participating in the Whole Child Model (WCM) Program should not utilize the California Children’s Services Exhibit F of the LHD MOU and instead should utilize the WCM MOU.

​​The WCM MOU can be found ​​​​​​​​​​​​​​​​​​​​at the California Children’s Services Whole Child Model website.​​

MOUs Effective July 1, 2024

​

​Important Updates 

​​DHCS will post important updates as they become available.

• DHCS released a Frequently Asked Questions document to be utilized by MCPs and Third Parties on December 20, 2023.​
  
• DHCS released the finalized TCM MOU Template on March 26, 2024. ​
• DHCS released the DMC State Plan MOU Template and BHIN 24-016​ on May 6th, 2024.
• DHCS is developing the 2025 MOU Templates. Additional information will be forthcoming.  ​​​

Key Documents

DHCS will post key documents as they become available, including:

• ​All Plan Letter 23-029
  
• ​​Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans and Medi-Cal Mental Health Plans Behaivoral Health Information Notice (BHIN)
  
• Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans and Drug Medi-Cal Organized Delivery System Counties BHIN​ ​
• Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans​ and Drug Medi-Cal State Plan Counties BHIN​​
  
• Base MOU Template
• Quarterly Reporting Template​ for MCPs​​​​​​
• Frequently Asked Questions​