SFHP Medical Criteria

SFHP uses external criteria MCG care guidelines, State/Federal (Medi-Cal/CMS), and when available and, in limited circumstances, internally developed and approved criteria (available below). The public, including providers and members, may obtain the relevant UM criteria for specific medical procedures or conditions on request at no cost.

UM Criteria for Gender Affirming Services

UM Criteria for EPSDT Private Duty Nursing

Custodial Care Criteria