Summary
Summary: Medi-Cal, California’s Medicaid program, is the state’s health insurance program for Californians with low incomes, including nearly 4 in 10 children, one in five nonelderly adults, and two million seniors and people with disabilities. It also pays for more than 50% of all births in the state and 55% of all patient days in long-term care facilities. In total, over 13 million Californians — one in three — rely on the program for health coverage. Medi-Cal pays for essential primary, specialty, acute, behavioral health, and long-term care services.
The Affordable Care Act allowed states the option to expand Medicaid, and California added over four million adults with low incomes to the program. Using only state resources, California also expanded Medi-Cal to cover three groups in households with low incomes regardless of immigration status: children, adults under 26, and in 2022, adults ages 50 and over.
This report presents findings about the Medi-Cal program based on the most recent data available.
Findings: Key findings include:
- In fiscal year 2019–20, Medi-Cal brought in more than $65 billion in federal funds and accounted for nearly 16% of all state general fund spending.
- People with disabilities composed 9% of Medi-Cal enrollees, but accounted for 31% of spending. Meanwhile, children accounted for 17% of enrollees, but just 6% of spending.
- 85% of people served by Medi-Cal were enrolled in one of six managed care models.
- More than three out of four Medi-Cal enrollees are in households where they or another family member works part- or full-time.
- Starting in March 2020, the COVID-19 pandemic, ensuing economic downturn, and related policy changes resulted in hundreds of thousands of people enrolling in, or retaining, Medi-Cal coverage.
- The state has proposed innovations and changes aimed at improving care for Medi-Cal members.
The Medi-Cal program faces numerous changes in the coming years, including procuring new contracts with managed care plans, which provide services to 11 million Medi-Cal enrollees in all 58 counties, and transitioning pharmaceutical benefits from managed care plans to the centralized Medi-Cal Rx program. Medi-Cal will also address the needs and costs of an aging population and implement strategies to address disparities in access, quality, and outcomes of care for enrollees of color.
This report uses data from the 2013, 2018, and 2019 California Health Interview Surveys (CHIS).
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