County Programs: Required Agreements & Engagement

Health Net and Local Government Agencies (LGAs)

Founded in California more than 40 years ago, Health Net believes that every person deserves a safety net for their health, regardless of age, income, employment status or current state of health. Today, we provide health plan coverage for individuals and families – people who qualify for Medi-Cal or Medicare. Together with our 90,000 network providers, Health Net serves three million members across the state.

As one of the Medi-Cal Managed Care Plans (MCPs) in California, Health Net contracts with the Department of Health Care Services (DHCS) to provide high quality, accessible, and cost-effective health care through managed care delivery systems. Our Contract with DHCS requires us 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;
  • First 5 programs and providers;​​​
  • Regional Centers;
  • Women, Infants and Children Supplemental Nutrition Programs; and
  • California Department of Corrections and Rehabilitation, county jails, and youth correctional facilities.

At Health Net, we also believe that to reduce health disparity gaps and improve outcomes, we need to enhance access to quality care. That requires a robust whole-person health model that directly addresses social drivers. Progress relies on metrics, including by race and ethnicity. Health Net collaborates and works with various community partners, Local Government Agencies (LGAs) and other Third Party Entities to close gaps, provide quality care for members and improve our communities.

Memorandums of Understanding (MOUs)

The MOUs are intended to be effective tools for clarifying roles and responsibilities between Health Net, our partnering LGAs and other Third Parties Entities, to support local engagement, and facilitate care coordination and the exchange of information necessary to enable care coordination and improve the referral processes between Health Net, our partnering LGAs and other Third Party Entities. The MOUs are also intended to improve transparency and accountability by setting forth certain existing requirements for each party as it relates 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 Health Net Contract with DHCS;
• Clarify roles and responsibilities for coordination of the delivery of care and services of all Members, particularly across Medi-Cal managed care plan carved out services, which may be provided by the Third Party Entity;
• Establish negotiated and agreed upon processes for how Health Net, partnering LGAs and other Third Party Entities will collaborate and coordinate on population health and/or other programs and initiatives;
• Memorialize what data will be shared between Health Net, partnering LGAs and other 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 Health Net, our partnering LGAs and other Third Party Entities; and
• Provide mechanisms for the parties to resolve disputes and ensure overall oversight and accountability under the MOU.

Health Net's Contract with DHCS requires us to execute an MOU with each of the LGAs and Third Party Entities outlined below. DHCS has developed MOU templates for Medi-Cal managed care plans, LGAs and Third Party Entities to utilize in this process to ensure that all Contract provisions for MOUs are captured and provide standardization in reporting. Each MOU is a binding, contractual agreement between Health Net, partnering LGAs and/or Third Party Entities which outlines the responsibilities and obligations of Health Net, our partnering LGAs and/or Third Party Entities to coordinate and facilitate whole-system, person centered care for local Medi-Cal members.

MOUs​​​​ Between Medi-Cal Managed Care Plans and Third Party Entities

DHCS has developed a webpage that contains all related resources and reference materials for the Memoranda​ of Understanding​​​​ Between Medi-Cal Managed Care Plans and Third Party Entities.

Health Net Counties

Health Net is contracted with DHCS to provide Medi-Cal services in the following California counties:

Quarterly Meetings

One of the minimum MOU components required by the Health Net Contract with DHCS requires Health Net to meet at least quarterly with our partnering LGAs and other Third-Party Entities to ensure proper oversight of the executed MOU and address care coordination, Quality Improvement ("Q") activities, QI outcomes, systemic and case specific concerns, and communication with others within the collective organizations about such activities.

Health Net Medi-Cal County Quarterly Meetings

Health Net Medi-Cal DHCS Annual Report

The MOU Annual Report is intended to summarize Health Net’s annual review process, any amendments that were made to the MOU or policies and procedures, and the outcomes of the review. An executed MOU means an MOU that has been reviewed and approved by DHCS, if applicable, and subsequently signed by all relevant parties to the MOU.

Annually, Health Net must report on each executed MOU that was in effect during the reporting year. For MOUs that become effective during the reporting year, Health Net must report on the MOU-related activities during the period that the MOU was effective.

Health Net must review their executed MOUs annually with the Other Parties to see if any amendments to the MOU are necessary. This includes, but is not limited to, incorporating any new Health Net contract requirements and/or policy guidance.