The Department of Health Care Services’ (DHCS) Medi-Cal Program is required to seek advice from Tribes and designees of Indian Health Programs and Urban Indian Organizations on Medi-Cal matters having a direct effect on Indians, Indian Health Programs or Urban Indian Organizations per the American Recovery and Reinvestment Act of 2009 (ARRA).   DHCS must solicit the advice of tribes and designees of Indian health programs prior to submission to Centers for Medicare and Medicaid Services (CMS) of any State Plan Amendment (SPA), waiver requests, waiver renewals, or waiver modifications, or proposals for demonstration projects in the Medi-Cal program.  Proposed changes to the Medi-Cal program are submitted quarterly to CMS for approval.
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ລັດໄດ້ຮັບຄໍາແນະນໍາກ່ຽວກັບການຈັດຕັ້ງປະຕິບັດຂໍ້ກໍານົດຂອງ ARRA ນີ້ໂດຍຜ່ານ State Medicaid Directors Letter 10-001.​​ 

CMS ໄດ້ອະນຸມັດຂະບວນການ DHCS ເພື່ອຂໍຄຳແນະນຳກ່ຽວກັບການປ່ຽນແປງທີ່ສະເໜີໃຫ້ໂຄງການ Medi-Cal ຕາມທີ່ໄດ້ກຳນົດໄວ້ໃນ SPA 12-002.​​ 

DHCS ຊີ້ທິດທາງການສື່ສານກ່ຽວກັບການປ່ຽນແປງທີ່ສະເໜີຕໍ່ໂຄງການ Medi-Cal ຕາມທີ່ໄດ້ກຳນົດໄວ້ໃນ SPA 12-002 ຕໍ່ກຸ່ມຕໍ່ໄປນີ້:​​ 

• ລາຍຊື່ຜູ້ອອກແບບໂຄງການສຸຂະພາບອິນເດຍໃນປະຈຸບັນ​​ 
• ບັນຊີລາຍຊື່ປະທານຊົນເຜົ່າຄາລິຟໍເນຍໃນປະຈຸບັນ​​