Family PACT

Provider Enrollment


New  Deactivation of Non-Participating Family PACT Providers

Effective January 1, 2019, the Department of Health Care Services will begin the process to deactivate providers from the Family PACT Program who have not submitted a claim for reimbursement from the program for one year.

Pursant to Welfare and Institution Code 24005 (i)(3), the department shall deactivate, immediately and without prior notice […] when a provider has not submitted a claim for reimbursement from the program for one year.

Deactivation from the Family PACT Program does not affect Medi-Cal enrollment. Deactivated providers will be notified by letter sent to the address on file.


Application Process

Solo providers, group providers or primary care clinics, who currently have a National Provider Identifier (NPI), are enrolled in good standing with Medi-Cal, and have the family planning skills, competency and knowledge to provide comprehensive family planning are eligible to apply for enrollment into the Family Planning, Access, Care, and Treatment (Family PACT) Program. Providers must be able to provide the full range of services covered in the Program. Providers that are interested in enrolling into the Family PACT Program must apply for enrollment by completing and submitting an application packet. Please familiarize yourself with the requirements of the Family PACT program and its provider enrollment requirements which can be found in the Family PACT Program’s Policies, Procedures and Billing Instructions Manual .

The application packet shall be completed by the provider applicant only. Effective November 1 2018, applications received by third party consultants or enrollment brokers on behalf of the provider applicant will not be accepted.     


The current DHCS 4468 application (12/2018) must be used when submitting an application to the Family PACT Program. Any packet submitted with an outdated application will be returned.

Please complete a Family PACT provider application packet and return to:


Department of Health Care Services
Office of Family Planning
P.O. Box 997413 MS 8400
Sacramento, California, 95899-7413

Physicians and Non-Physician Medical Practitioners (NMPs) employed by a Medi-Cal provider who is applying to enroll in the Family PACT Program and who will be delivering Family PACT services must be identified on the Provider Application (DHCS 4468), complete a Family PACT Program Provider Agreement (DHCS 4469)*, complete a Family PACT Program Practitioner Participation Agreement (DHCS 4470)*, and are required to complete the trainings identified on the Learning Management System (LMS). Please visit the LMS at for more information.

*The DHCS 4469 and DHCS 4470 will be provided to applicants upon approval of the DHCS 4468 form.
Please Note: The DHCS 4470 is not required to be completed by Primary Care Clinics, Affiliate Primary Care Clinics, FQHCs, RHCs, IHCs, and government providers.

Provisional Enrollment Period

New Family PACT service sites are provisionally certified for enrollment in Family PACT until an eligible representative completes the legislatively mandated Provider Orientation per Welfare and Institutions Code (W&I Code), Section (§) 24005(k). The Provider Orientation must be completed within six (6) months of the date of initial Family PACT enrollment for the provisional certification to be lifted. Failure to complete the orientation within six (6) months will result in disenrollment. Please visit our Learning Management System (LMS) at for a complete list of required trainings and training locations.


1. Email  Submit Family PACT application via secure email 
2. Register in LMS  Register in LMS 
3. In Person Orientation  Complete the Provider Orientation Modules 
4. In Person Orientation  Register/attend an In Person Orientation 
5. Provisional Enrollment Period  Complete the Provisional Enrollment Period 

Please contact the Office of Family Planning by phone (916) 650-0414 or email us at if you have any questions regarding the Provider Enrollment process.

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