Medi-Cal

The California Medical Assistance Program is the California implementation of the federal Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level. Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental, vision, and long-term care and support. Medi-Cal was created in 1965 by the California Medical Assistance Program a few months after the national legislation was passed. Approximately 15.28 million people were enrolled in Medi-Cal as of September 2022, or about 40% of California's population; in most counties, more than half of eligible residents were enrolled as of 2020. As of 2025, about 56% of children in California use the program.

Eligibility

Medi-Cal provides health coverage for people with low income and limited ability to pay for health coverage, including the aged, blind, disabled, young adults and children, pregnant women, persons in a skilled nursing or intermediate care home, and persons in the Breast and Cervical Cancer Treatment Program. People receiving federally funded cash assistance programs, such as CalWORKs, the State Supplementation Program , foster care, adoption assistance, certain refugee assistance programs, or In-Home Supportive Services are also eligible.
Until January 1, 2024, when asset limits for Medi-Cal were abolished in favor of income limits, Medi-Cal imposed asset limits on certain prospective enrollees. Medi-Cal individuals who received long-term supportive services or who enroll in Medi-Cal through certain disabilities were subject to asset tests. This limit depended on the number of individuals being considered for coverage; for one enrollee, this limit was $2,000, while for two enrollees, the limit was $3,000. Each additional individual being considered resulted in an additional $150 of permitted assets, up to a total of ten individuals covered. If applicants possessed property whose total value exceeded the allowed amount, they were required to reduce their assets through activities such as purchasing clothes, purchasing home furnishings, paying medical bills, paying a home mortgage, paying home loans, and paying off other debts.
Beginning in 2014 under the Patient Protection and Affordable Care Act, those with family incomes up to 138% of the federal poverty level became eligible for Medi-Cal ), and individuals with higher incomes and some small businesses may choose a plan in Covered California, California's health insurance marketplace, with potential government subsidies. Medi-Cal has open enrollment year-round.
Lawful permanent residents are eligible for full-scope Medi-Cal in California regardless of their date of entry if they meet all other eligibility requirements, even if they have been in the United States for less than 5 years. Beginning in 2024, people without a lawful immigration status who meet the requirements for Medi-Cal are eligible for full-scope Medi-Cal. Previously, meeting eligibility requirements other than immigration status qualified them restricted-scope Medi-Cal limited to emergency and pregnancy-related services only unless they qualified for the Young Adult Expansion or Older Adult Expansion, which allowed individuals ages 19–26 or those over the age of 50 full-scope benefits regardless of immigration status.

Application process

There are multiple ways to apply for Medi-Cal: one can apply at a Social Services office or over the phone by calling your nearest social service office, or one can apply online. Most websites make the application process clear and cohesive. They also allow for the user to select different languages to best navigate the .
Individuals in need of Medi-Cal often need help with their use of the online application process and face barriers, including

Rejection of applications due to insufficient explanation
Repeated requests for additional documentation throughout the application process
Unclear next steps and transitions in the application process, both for applications submitted directly to Medi-Cal and those initiated through Covered California
Difficulty accessing support and personalized assistance, including in-language help and resources for Spanish- and Mandarin-speaking applicants
Challenges in navigating Medi-Cal eligibility and enrollment during significant life transitions, such as aging out of foster care, transitioning off a parent’s health insurance plan, giving birth, getting a divorce, or losing or gaining employer-sponsored insurance.
Sometimes, individuals don’t have access to the internet or experience confusion.

Online applications seem to pose difficulty for those who aren’t tech-savvy. People can apply in-person or over the phone to avoid such confusion.

Benefits

Medi-Cal health benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental, vision, and long-term care and supports. California is one of a few US states that provide Medicaid dental benefits to adults.
A patchwork of supplemental programs has grown up to fill in some of the gaps, including Federally Qualified Health Centers, a designation that refers to hundreds of health clinics and systems that operate in underserved, low-income and uninsured communities.

Administration

Medi-Cal fee for service

As of December 2022, 2.2 million people were enrolled in Medi-Cal fee-for-service, representing about 14.5% of all enrollees. In the fee-for-service arrangement, health care providers submit claims to the Medi-Cal program for services rendered.

Medi-Cal managed care

Most beneficiaries receive Medi-Cal benefits from contracted Medicaid managed care organizations. As of January 2018, 10.8 million people were enrolled in a Medi-Cal managed care plan, representing about 81% of all enrollees.
California has several models of managed care which are designated at the county level:

a County Organized Health System model, with one health plan per county,
a "two plan model" with one community health plan and one commercial health plan in the county,
a geographic managed care model with multiple plans per county,
a regional managed care model with 1-2 commercial health plans in many counties,
and unique one-county models in San Benito, Imperial counties and the bi-county plan "CenCal Health" in San Luís Obispo and Santa Barbara.

In Denti-Cal, the majority of beneficiaries are covered through fee-for-service arrangements, where the state pays dentists directly for services, instead of the managed care model. However, more than 879,000 Denti-Cal enrollees do receive dental care through managed care plans started as experimental alternatives in the 1990s: in Los Angeles County where managed care plans are optional for beneficiaries, and in Sacramento County where they are mandatory. Eleven counties had no Denti-Cal providers or no providers willing to accept new child patients covered by Denti-Cal: Del Norte, Tehama, Yuba, Sierra, Nevada, Amador, Calaveras, Alpine, Mariposa, Mono and Inyo counties. Delta Dental, operating in the same building as DHCS' Denti-Cal division, enrolls dentists into DentiCal, processes claims by dentists, pays dentists and authorizes treatments, and also handles customer service operations and outreach.

Bridge to Reform waiver

In 2011, CMS approved a Section 1115 Medicaid waiver called Bridge to Reform. The program included an expansion of the patient-centered medical home primary care approach, an expansion of coverage with the Low Income Health Program, and incentive pay-for-performance to hospitals via the Delivery System Reform Incentive Pool. It also made enrollment in managed care plans mandatory for people with disabilities with the intention of improving care coordination and reducing costs. The DSRIP program showed improvements in quality of care and population health, with less improvement in cost of care.
Renewal of the waiver in 2015 extended the program to 2020 in an initiative called Medi-Cal 2020, with additional programs including additional alternative payment systems, the Dental Transformation Initiative, and the Whole Person Care program focused on high-risk, high-utilizing recipients. In the negotiation with CMS, several proposals were dropped.

Contractual requirements

Medi-Cal enforces requirements on MCOs with contracts, with boilerplate versions posted online; these contracts the primary way that the state affects the operations, quality, and coverage of managed care plans. In 2005, the California Health Care Foundation recommend various steps to improve the plans, which resulted in some changes to the contracts.

Government agencies

Medi-Cal is jointly administered by the Centers for Medicare and Medicaid Services and the California Department of Health Care Services, while the county welfare department in each of the 58 counties is responsible for local administration of the Medi-Cal program. C4Yourself and CalWIN are statewide online application systems that allows you to apply for benefits.

County	Department/Agency	SAWS consortium	Managed care model	Managed care plan
Alameda		CalWIN	Single-plan plus Kaiser	,
Alpine		C4Yourself	Two-plan	,
Amador		C4Yourself	Single-plan plus Kaiser	,
Butte		C4Yourself	COHS	Partnership HealthPlan of California
Calaveras		C4Yourself	Regional	,
Colusa		C4Yourself	COHS	Partnership HealthPlan of California
Contra Costa		CalWIN	Single-plan plus Kaiser	,
Del Norte	Department of Health and Human Services	C4Yourself	COHS	Partnership HealthPlan of California
El Dorado		C4Yourself	Two-plan plus Kaiser	, ,
Fresno		CalWIN	Two-plan plus Kaiser	, ,
Glenn		C4Yourself	COHS	Partnership HealthPlan of California
Humboldt		C4Yourself	COHS	Partnership HealthPlan of California
Imperial		C4Yourself	Single-plan plus Kaiser	,
Inyo	Department of Health and Human Services	C4Yourself	Regional	,
Kern		C4Yourself	Two-plan plus Kaiser	, ,
Kings		C4Yourself	Two-plan plus Kaiser	, ,
Lake		C4Yourself	COHS	Partnership HealthPlan of California
Lassen		C4Yourself	COHS	Partnership HealthPlan of California
Los Angeles		LEADER	Two-plan plus Kaiser	, ,
Madera		C4Yourself	Two-plan plus Kaiser	, ,
Marin		C4Yourself	COHS plus Kaiser	Partnership HealthPlan of California,
Mariposa		C4Yourself	COHS plus Kaiser	,
Mendocino		C4Yourself	COHS	Partnership HealthPlan of California
Merced		C4Yourself	COHS
Modoc		C4Yourself	COHS	Partnership HealthPlan of California
Mono		C4Yourself	Regional	,
Monterey		C4Yourself	COHS
Napa		C4Yourself	COHS plus Kaiser	Partnership HealthPlan of California,
Nevada		C4Yourself	COHS	Partnership HealthPlan of California
Orange		CalWIN	COHS plus Kaiser	,
Placer		CalWIN	COHS plus Kaiser	Partnership HealthPlan of California,
Plumas		C4Yourself	COHS	Partnership HealthPlan of California
Riverside		C4Yourself	Two-plan plus Kaiser	, ,
Sacramento		CalWIN	Geographic Managed Care	, , ,
San Benito		C4Yourself	COHS
San Bernardino		C4Yourself	Two-plan plus Kaiser	, ,
San Diego		CalWIN	Geographic Managed Care	, , , ,
San Francisco		CalWIN	Two-plan plus Kaiser	, ,
San Joaquin		C4Yourself	Two-plan plus Kaiser	, ,
San Luis Obispo		CalWIN	COHS
San Mateo		CalWIN	COHS plus Kaiser	,
Santa Barbara		CalWIN	COHS
Santa Clara		CalWIN	Two-plan plus Kaiser	, ,
Santa Cruz		CalWIN	COHS plus Kaiser	,
Shasta		C4Yourself	COHS	Partnership HealthPlan of California
Sierra		C4Yourself	COHS	Partnership HealthPlan of California
Siskiyou		C4Yourself	COHS	Partnership HealthPlan of California
Solano		CalWIN	COHS plus Kaiser	Partnership HealthPlan of California,
Sonoma		CalWIN	COHS plus Kaiser	Partnership HealthPlan of California,
Stanislaus		C4Yourself	Two-plan plus Kaiser	, ,
Sutter		C4Yourself	COHS plus Kaiser	Partnership HealthPlan of California,
Tehama		C4Yourself	COHS	Partnership HealthPlan of California
Trinity		C4Yourself	COHS	Partnership HealthPlan of California
Tulare		CalWIN	Regional plus Kaiser	, , ,
Tuolumne		C4Yourself	Regional	,
Ventura		CalWIN	COHS plus Kaiser	,
Yolo		CalWIN	COHS plus Kaiser	Partnership HealthPlan of California,
Yuba		C4Yourself	COHS plus Kaiser	Partnership HealthPlan of California,