REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 17, 2026
FROM
JANKI PATEL, Acting Director, Department of Public Health
SUBJECT
Title
Medi-Cal Provider Enrollment Agreement and Related Forms for Department of Health Care Services
End
RECOMMENDATION(S)
Recommendation
1. Approve the Department of Health Care Services Medi-Cal Provider Agreement, Medi-Cal Disclosure Statement, and Medi-Cal Provider Application to complete an official address change for the San Bernardino Federally Qualified Health Center as a Medi-Cal provider.
2. Authorize the Director of the Department of Public Health to execute and submit the Department of Health Care Services Medi-Cal Provider Agreement, Medi-Cal Disclosure Statement, Medi-Cal Provider Application, and any subsequent non-substantive amendments or supplemental enrollment Medi-Cal application documents necessary to complete an official address change for the San Bernardino Federally Qualified Health Center as a Medi-Cal provider, subject to review by County Counsel.
3. Direct the Director of Public Health to transmit the Provider Agreement, Medi-Cal Disclosure Statement, Medi-Cal Provider Application, and any subsequent non-substantive amendments to the Clerk of the Board of Supervisors within 30 days of execution.
(Presenter: Janki Patel, Acting Director, 387-9146)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Improve County Government Operations.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost) as the Department of Health Care Services (DHCS) Medi-Cal Provider Agreement, Medi-Cal Disclosure Statement, and Medi-Cal Provider Application are non-financial in nature. However, once the agreements are in place, the Department of Public Health (DPH) will be able to resume claim reimbursement for Medi-Cal services provided.
BACKGROUND INFORMATION
DPH operates Federally Qualified Health Centers (FQHCs) in Adelanto, Hesperia, Ontario and San Bernardino. FQHCs provide comprehensive health services for underserved populations and qualify for enhanced reimbursement from Medicare and Medi-Cal. Enrollment with DHCS as a Medi-Cal provider allows DPH’s FQHCs to submit claims for reimbursement for covered services. The DHCS enrollment documents contain binding provisions that require Board of Supervisors’ approval.
In 2024, the San Bernardino FQHC relocated to its current location at 590 North D Street. DPH continued to receive Medi-Cal reimbursement for services at the San Bernardino FQHC while working to update the address with DHCS. Incomplete guidance and lack of clear direction concerning the address-change reporting process contributed to an approval delay. In August 2026, DPH received notification that the previous submission for the San Bernardino FQHC change of address could not be finalized. To maintain eligibility following an address change, DHCS requires submission of a full paper Medi-Cal application consisting of the Medi-Cal Provider Agreement, Medi-Cal Disclosure Statement, and Medi-Cal Provider Application.
DPH recommends approval of this item to allow the San Bernardino FQHC to complete the official address change in order to continue to receive reimbursement for eligible services.
PROCUREMENT
Non applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Adam Ebright, Deputy County Counsel, 387-5455) on October 30, 2026; and County Finance and Administration (Guy Martrinez, Principal Administrative Analyst, 386-5428) on October 30, 2026.