Medi-Cal

California implementation of Medicaid
The California Medical Assistance Program (Medi Cal or MediCal) 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 (Denti Cal), vision, and long term care and support. 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.

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 (BCCTP). People receiving federally funded cash assistance programs, such as CalWORKs (a state implementation of the federal Temporary Assistance for Needy Families (TANF) program), the State Supplementation Program (SSP) (a state supplement to the federal Supplemental Security Income (SSI) program), foster care, adoption assistance, certain refugee assistance programs, or In Home Supportive Services (IHSS) are also eligible. Each additional individual being considered results in an additional $150 of permitted assets, up to a total of ten individuals covered. If applicants possess property whose total value exceeds the allowed amount, they are required to reduce ("sell down") 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. Medi Cal has open enrollment year round. Lawful permanent residents (green card holders) 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 (YAE) or Older Adult Expansion (OAE), which allowed individuals ages 19–26 or those over the age of 50 full scope benefits regardless of immigration status.

Medi Cal health benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti Cal), vision, and long term care and supports. California is one of a few US states that provide Medicaid dental benefits to adults.

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. C4Yourself and CalWIN are statewide online application systems that allows you to apply for benefits. + County welfare departments and Medi Cal Managed Care Plans County Department/Agency SAWS consortium Managed care model Managed care plan(s) Alameda Social Services Agency CalWIN Single plan plus Kaiser Alameda Alliance for Health, Kaiser Permanente Alpine Department of Social Services C4Yourself Two plan Anthem Blue Cross, Mountain Valley Health Plan Amador Department of Social Services C4Yourself Single plan plus Kaiser Anthem Blue Cross, Kaiser Permanente Butte Department of Employment and Social Services C4Yourself COHS Partnership HealthPlan of California Calaveras Department of Calaveras Works and Human Services C4Yourself Regional Anthem Blue Cross, Health Net Community Solutions Colusa Department of Health and Human Services C4Yourself COHS Partnership HealthPlan of California Contra Costa Department of Employment and Human Services CalWIN Single plan plus Kaiser Contra Costa Health Plan, Kaiser Permanente Del Norte Department of Health and Human Services C4Yourself COHS Partnership HealthPlan of California El Dorado Department of Human Services C4Yourself Two plan plus Kaiser Anthem Blue Cross, Mountain Valley Health Plan, Kaiser Permanente Fresno Department of Social Services CalWIN Two plan plus Kaiser Anthem Blue Cross, CalViva Health, Kaiser Permanente Glenn Human Resources Agency C4Yourself COHS Partnership HealthPlan of California Humboldt Department of Health and Human Services C4Yourself COHS Partnership HealthPlan of California Imperial Department of Social Services C4Yourself Single plan plus Kaiser Community Health Plan of Imperial Valley, Kaiser Permanente Inyo Department of Health and Human Services C4Yourself Regional Anthem Blue Cross, Health Net Community Solutions Kern Department of Human Services C4Yourself Two plan plus Kaiser Anthem Blue Cross, Kern Family Health Care, Kaiser Permanente Kings Human Services Agency C4Yourself Two plan plus Kaiser Anthem Blue Cross, CalViva Health, Kaiser Permanente Lake Department of Social Services C4Yourself COHS Partnership HealthPlan of California Lassen Lassen WORKS C4Yourself COHS Partnership HealthPlan of California Los Angeles Department of Public Social Services LEADER Two plan plus Kaiser L. A. Care Health Plan, Health Net, Kaiser Permanente Madera Department of Social Services C4Yourself Two plan plus Kaiser Anthem Blue Cross, CalViva Health, Kaiser Permanente Marin Department of Health and Human Services C4Yourself COHS plus Kaiser Partnership HealthPlan of California, Kaiser Permanente Mariposa Department of Human Services C4Yourself COHS plus Kaiser Central California Alliance for Health, Kaiser Permanente Mendocino Health and Human Services Agency C4Yourself COHS Partnership HealthPlan of California Merced Human Services Agency C4Yourself COHS Central California Alliance for Health Modoc Department of Social Services C4Yourself COHS Partnership HealthPlan of California Mono Department of Social Services C4Yourself Regional Anthem Blue Cross, Health Net Community Solutions Monterey Department of Social and Employment Services C4Yourself COHS Central California Alliance for Health Napa Department of Health and Human Services C4Yourself COHS plus Kaiser Partnership HealthPlan of California, Kaiser Permanente Nevada Human Services Agency C4Yourself COHS Partnership HealthPlan of California Orange Social Services Agency CalWIN COHS plus Kaiser CalOptima, Kaiser Permanente Placer Department of Health and Human Services CalWIN COHS plus Kaiser Partnership HealthPlan of California, Kaiser Permanente Plumas Department of Social Services C4Yourself COHS Partnership HealthPlan of California Riverside Department of Public Social Services C4Yourself Two plan plus Kaiser Inland Empire Health Plan, Molina Healthcare, Kaiser Permanente Sacramento Department of Human Assistance CalWIN Geographic Managed Care (GMC) Molina Healthcare, Anthem Blue Cross, Health Net, Kaiser Permanente San Benito Health and Human Services Agency C4Yourself COHS Central California Alliance for Health San Bernardino Department of Human Services C4Yourself Two plan plus Kaiser Inland Empire Health Plan, Molina Healthcare, Kaiser Permanente San Diego Health and Human Services Agency CalWIN Geographic Managed Care (GMC) Blue Shield of California Promise Health Plan, Molina Healthcare, Health Net, Kaiser Permanente, Community Health Group San Diego San Francisco Human Services Agency CalWIN Two plan plus Kaiser San Francisco Health Plan, Anthem Blue Cross, Kaiser Permanente San Joaquin Human Services Agency C4Yourself Two plan plus Kaiser Health Net, Health Plan of San Joaquin, Kaiser Permanente San Luis Obispo Department of Social Services CalWIN COHS CenCal Health San Mateo Human Services Agency CalWIN COHS plus Kaiser Health Plan of San Mateo, Kaiser Permanente Santa Barbara Department of Social Services CalWIN COHS CenCal Health Santa Clara Social Services Agency CalWIN Two plan plus Kaiser Santa Clara Family Health Plan, Anthem Blue Cross, Kaiser Permanente Santa Cruz Department of Human Services CalWIN COHS plus Kaiser Central California Alliance for Health, Kaiser Permanente Shasta Health and Human Services Agency C4Yourself COHS Partnership HealthPlan of California Sierra Department of Social Services C4Yourself COHS Partnership HealthPlan of California Siskiyou Department of Human Services C4Yourself COHS Partnership HealthPlan of California Solano Department of Health and Social Services CalWIN COHS plus Kaiser Partnership HealthPlan of California, Kaiser Permanente Sonoma Department of Human Services CalWIN COHS plus Kaiser Partnership HealthPlan of California, Kaiser Permanente Stanislaus Community Services Agency C4Yourself Two plan plus Kaiser Health Net, Health Plan of San Joaquin, Kaiser Permanente Sutter Department of Human Services C4Yourself COHS plus Kaiser Partnership HealthPlan of California, Kaiser Permanente Tehama Department of Social Services C4Yourself COHS Partnership HealthPlan of California Trinity Dept of Health and Human Services C4Yourself COHS Partnership HealthPlan of California Tulare Health and Human Services Agency CalWIN Regional plus Kaiser Anthem Blue Cross, California Health & Wellness, Health Net Community Solutions, Kaiser Permanente Tuolumne Department of Social Services C4Yourself Regional Anthem Blue Cross, Health Net Community Solutions Ventura Human Services Agency CalWIN COHS plus Kaiser Gold Coast Health Plan, Kaiser Permanente Yolo Department of Employment and Social Services CalWIN COHS plus Kaiser Partnership HealthPlan of California, Kaiser Permanente Yuba Department of Health and Human Services C4Yourself COHS plus Kaiser Partnership HealthPlan of California, Kaiser Permanente

Federal law mostly consists of the Social Security Amendments of 1965 which added Title XIX to the Social Security Act ( et seq. ), and related California law mostly consists of California Welfare and Institutions Code (WIC) Division 9, Part 3, Chapter 7 (WIC § 14000 et seq.). Federal regulations are mostly found in Code of Federal Regulations (CFR) Title 42, Chapter IV, Subchapter C ( et seq. ); while California's regulations are contained in California Code of Regulations (CCR) Title 22, Division 3 (22 CCR § 50005).

Medi Cal costs are estimated at $73.9 billion ($16.9 billion in state funds) in 2014–15. For comparison, the entire California state budget in 2014 2015 is $156 billion, of which about $108 billion was general funds (not allocated for special expenditures, such as bonds).

The Long Term Care Partnership Program is a public private partnership between states and private insurance companies, designed to reduce Medicaid expenditures by delaying or eliminating the need for some people to rely on Medicaid to pay for long term care services. To encourage the purchase of private partnership policies, long term care insurance policyholders are allowed to protect some or all of their assets from Medicaid spend down requirements during the eligibility determination process, but they still must meet income requirements. The California Partnership for Long Term Care Program links Medi Cal and the In Home Supportive Services program, i. e., private long term care insurance and health care service plan contracts that cover long term care for aged, blind, or disabled persons.

Covered California is the health insurance marketplace in California, the state's implementation of the American Health Benefit Exchange provisions of the Patient Protection and Affordable Care Act.

Since 1933, California law has required counties to provide relief to the poor, including health care services and general assistance. County indigent medical programs can be categorized as California Medical Service Program (CMSP) and Medically Indigent Service Program (MISP) counties. There are 34 CMSP counties and 24 MISP counties. The CMSP county programs are largely managed by the state, whereas MISP counties manage their own programs with their own rules and regulations. Many patients from both the CMSP and MISP county programs transitioned to Medi Cal when the Patient Protection and Affordable Care Act took effect in 2014.

Medi Cal reports quality metrics, broadly similar to the HEDIS metrics from the NCQA. In 2017, it reported on 13 of the 20 frequently reported from the CMS Medicaid/CHIP Child Core Set and 15 of 19 frequently reported from the CMS Medicaid Adult Core Set.