Tribal Health Programs
Tribal Federally Qualified Health Center (FQHC) and Indian Health Service Memorandum of Agreement (IHS/MOA) providers are required to submit their applications via PAVE (Provider Application and Validation for Enrollment). Tribal Health Programs that are primary care clinics located in California are exempt from licensure per California’s Health and Safety Code, Sections 1206(c)(1) and 1206(c)(2). Tribal Health Programs who wish to enroll as a Medi-Cal provider and who are asserting exemption from licensure must complete the PAVE application process as outlined below. Tribal Health Programs must confirm that an Indian Health Services or the Tribal 638 facility elects to participate under the Indian Health Services Memorandum of Agreement (IHS/MOA) program or the Tribal 638 facility elects to participate as a Tribal Federally Qualified Health Center (Tribal FQHC). If the Tribal Health Program is not exempt from licensure, they must obtain licensure from the California Department of Public Health (CDPH) and submit an “Elect to Participate” IHS/MOA and Tribal FQHC Application (DHCS 7108) to DHCS. Application Fee
Note: Tribal Heath Programs may also be exempt from the application fee if they provide a letter from the Centers for Medicare and Medicaid Services stating that clinic site is enrolled in Medicare.
Required Documents
Gather the required documents listed below, as applicable, in order to upload them into PAVE as you complete your PAVE application.
Please ensure the uploaded documents are legible.
- Federal Employer Identification Number (FEIN) or Individual Taxpayer Identification Number (ITIN) verification, if a social security number is not used, by submitting a current Internal Revenue Service (IRS) generated document. The only acceptable documents include an IRS-generated Letter 147-C, IRS-generated Form 941 (Employer’s Quarterly Federal Tax Return), IRS-generated Form 8109-C (Deposit Coupon), or IRS-generated Form SS-4 (only the official Confirmation Notification of FEIN/ITIN assignment). Note: The legal name of the applicant or provider on the application must exactly match the name on the IRS-generated document; and the applicant/provider must be an owner or officer of the entity listed on the IRS document. For further information, please check with the IRS or call them at (800) 829-4933.
- Fully executed Partnership Agreement, if your business is a partnership. Processing delays may be avoided by indicating whether the entity is a General Partnership or Limited Partnership and also submitting the following:
a) For a General Partnership, a list of all partners with percentage of ownership or control interest for each; or
b) For a Limited Partnership, information identifying the General Partner, and a list of all partners with percentage of ownership or control interest for each.
To verify or change the name and/or status of your partnership or for further information, please visit the
Secretary of State California Business Portal and click on the "California Business Search" link or other appropriate link.
- If your business is a corporation, processing delays may be avoided by attaching a copy of the filed Articles of Incorporation and the "Statement of Information for a Domestic Stock Corporation" from the Secretary of State, with the percentage of ownership and control interest listed for each director and officer.
- To verify or change the name and/or status of your corporation or for further information, please visit the Secretary of State California Business Portal and click on the "California Business Search" link or other appropriate link.
- If your business is a limited liability company (LLC), processing delays may be avoided by attaching a copy of the Articles of Organization from the Secretary of State, with a list of the members and the percent of ownership and control interest listed for each.
- To verify or change the name and/or status of your LLC or for further information, please visit the Secretary of State California Business Portal and click on the "California Business Search" link or other appropriate link.
- Certificate of Commercial Liability Insurance (business, general, or comprehensive liability, or office premises insurance) in an amount of not less than $100,000 per claim and a minimum annual aggregate of $300,000, as required by law. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, effective dates, and limits of coverage. Note: The name and business address, including suite number if applicable, of the applicant or provider on the application must exactly match the insured’s name and address on the certificate of insurance or declaration sheet. Note: Tribal Health Programs may submit a cover letter noting reliance on Federal Torts Claims Coverage or wrap around coverage in lieu of other commercial liability insurance requirements list above.
- Certificate of Workers’ Compensation Insurance is required by California law, if your business has one or more employees. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, and effective dates. If no Workers’ Compensation insurance is required, an explanation must be provided. Note: The name and business address of the applicant or provider must exactly match the insured’s name and address on the certificate of insurance.
- Signed Lease Agreement, if business premises are not owned by the applicant or provider. Note: The name and business address of the applicant or provider must exactly match the lessee’s name and address on the lease agreement.
- Successor Liability with Joint and Several Liability Agreement (DHCS 6217), if applicable.
- “Elect To Participate” Indian Health Services Memorandum of Agreement (IHS/MOA) and Tribal Federally Qualified Health Center (Tribal FQHC) Application (DHCS 7108).
PAVE Portal
