California

Key Provisions

• No 'Business of Insurance' Exemption: Since California law does not explicitly state that DPC is not insurance, practices must carefully structure patient agreements to emphasize they are contracts for medical services, not risk-bearing insurance products, to avoid potential scrutiny from the California Department of Insurance.
• General Medical Practice Governance: DPC practices are subject to the same regulations as all other physician practices in the state. The Medical Board of California oversees all aspects of licensure, standards of care, professional conduct, and medical record-keeping.
• Contract Law Governs Patient Agreements: The relationship between a DPC practice and a patient is governed by general contract law. These private agreements must clearly define the scope of included services, the monthly fee structure, payment terms, and the process for termination by either the patient or the practice.
• No State-Level HSA Provisions: California law does not have any provisions allowing pre-tax health savings account (HSA) funds to be used for DPC membership fees. However, proposed federal legislation, like the Primary Care Enhancement Act, could enable this if passed, making DPC more accessible for individuals with HSAs.
• Emphasis on Supplemental Insurance: DPC practices in California must clearly communicate to patients that membership does not replace comprehensive health insurance. Patients are still responsible for maintaining separate coverage for services outside the scope of DPC, such as hospital care, specialist visits, advanced imaging, and major emergencies.

Medication Dispensing

California does not have DPC-specific laws for medication dispensing. Therefore, physicians in a DPC practice who wish to dispense medications directly to patients must comply with the general state laws and regulations governing physician dispensing. This requires registering with the Medical Board of California and adhering to its strict rules on labeling, storage, record-keeping, and patient counseling. The regulations are designed to ensure patient safety and apply to any physician dispensing from their office, regardless of the practice model.

Medicaid Provisions

California's Medicaid program, known as Medi-Cal, does not currently have any specific provisions, pilot programs, or waivers designed to integrate or reimburse for Direct Primary Care services. As a result, DPC practices in California generally cannot contract directly with Medi-Cal or bill the program for membership fees. This means that Medi-Cal beneficiaries typically cannot use their benefits to join a DPC practice, limiting the model's accessibility to this population.