Medi-Cal, California's Medicaid program, is administered by the Department of Health Care Services (DHCS) and delivers managed care through five distinct models that vary by county, rather than a single statewide MCO structure. Per CMS's most recent managed care enrollment data, report year 2024, Medi-Cal's managed care programs covered approximately 15.3 million members. Since January 1, 2026, DHCS has aligned a dually eligible beneficiary's Medi-Cal managed care plan choice statewide to follow their Medicare Advantage D-SNP plan choice, a policy previously in effect in only 17 counties.
California delivers Medi-Cal managed care through five models depending on county: Two-Plan Model (most populous counties, a Local Initiative public plan alongside a commercial plan), County Organized Health Systems (COHS, one public plan per county or region, mostly rural), Geographic Managed Care (GMC, member choice among several commercial plans, Sacramento and San Diego), Regional Model (a small cluster of Northern California counties), and Single-Plan Model (one plan per county: Alameda, Contra Costa, Imperial). Current 5-year MCP contracts took effect January 1, 2024.
Since January 1, 2024, CalAIM has carved institutional long-term care (skilled nursing, subacute care) and Community-Based Adult Services into Medi-Cal managed care plan contracts statewide, but In-Home Supportive Services (IHSS), by far the largest LTSS program by enrollment, remains outside managed care, run through county IHSS programs. The Program of All-Inclusive Care for the Elderly (PACE) also operates as a separate, fully integrated LTSS model for frail dual-eligible seniors, delivered through dozens of small county-based organizations rather than a handful of major vendors. SCAN Health Plan separately offers fully integrated dual eligible special needs plans that combine Medicare and Medi-Cal benefits, including in-home care, for dual eligibles 65 and older in Los Angeles, Riverside, San Bernardino, and San Diego counties.
Partially integrated into managed care
Specialty mental health services and Drug Medi-Cal/DMC-ODS substance use disorder treatment are carved out of managed care entirely, administered by 56 individual county Mental Health Plans rather than by the MCPs. Non-specialty (mild-to-moderate) mental health services remain a Medi-Cal managed care plan benefit. Effective January 1, 2025, California's BH-CONNECT Section 1115 demonstration added new incentive-based financing and expanded evidence-based practice service coverage for these county Behavioral Health Plans, without changing the underlying carve-out structure.
Carved out
Denti-Cal is delivered fee-for-service in all but two counties, administered by Gainwell Technologies as DHCS's Fiscal Intermediary-Dental Business Operations contractor. Dental Managed Care remains mandatory in Sacramento County and optional in Los Angeles County, with Health Net of California, Liberty Dental Plan of California, and California Dental Network as the current DMC plan lineup in both counties.
Pharmacy benefits are carved out of managed care entirely into Medi-Cal Rx, a single statewide fee-for-service program administered by Magellan Medicaid Administration since full assumption of operations on January 1, 2022.
Non-emergency medical transportation is not brokered through a single statewide contract: each Medi-Cal managed care plan contracts its own NEMT vendor or administers it directly (e.g. Modivcare for Health Net, direct county transit arrangements for CenCal Health).
The California Medicaid Management Information System (CA-MMIS), which processes fee-for-service claims and provider payments, is operated by Gainwell Technologies, the incumbent Fiscal Intermediary since October 2020.
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See them with ProThe Bay Area Air Quality Management District voted 16-1 to delay by a year its phaseout of gas water heaters, now requiring zero-nitrogen-oxide models starting January 2028 for most property owners replacing a unit. The amended rule exempts people with incomes at or below 80% of area median income or enrolled in programs such as Medi-Cal or CalFresh, those whose housing costs exceed 28% of gross income, and homes with physical barriers like cramped closets or outdated electrical panels. The air district estimates about 20% of households qualify for the income-based exemption and another 20% for physical-barrier exemptions, with staff estimating the exemptions could forgo roughly half the rule's originally projected pollution cuts. Larger water heaters common in apartment buildings now have until 2033 instead of 2031.
California's Proposition 42, which prohibits new taxes on personal property such as business holdings, intellectual property and financial assets, was leading at 54% with nearly 60% of votes counted. Billionaire-backed and endorsed by Gov. Gavin Newsom, the measure was placed on the ballot to counter Proposition 40, a competing billionaire wealth tax measure backed by SEIU-UHW and Rep. Ro Khanna. The nonpartisan Legislative Analyst's Office says Prop. 42 will make it harder for state lawmakers to raise taxes in the future and could reduce state revenue, though the amount is unclear; it also bars retroactive taxes except during a budget emergency. The ban is not permanent and could be undone by a future ballot measure, but California lawmakers have never advanced an asset tax proposal past committee despite Democratic supermajorities. The article notes California has faced four consecutive years of deficits leading to healthcare cuts, and that federal cuts to Medicaid will add pressure on Gov.-elect Xavier Becerra to backfill losses.
In a CalMatters commentary, the author argues that California's Proposition 40, a one-time 5% tax on billionaires' stocks, bonds and business holdings estimated to raise $100 billion for Medi-Cal, failed after opponents led by Sergey Brin spent $379 million to defeat it. The piece contends opponents successfully stoked fears that a legislative amendment clause could let lawmakers extend the tax to ordinary retirement accounts, and that a competing countermeasure, Proposition 42, barring taxes on personal property, was on track to pass. The author argues capital-flight fears driving the "no" campaign, including Gov. Newsom's opposition, are not supported by research, and that the measure's defeat reflects how money dominates California's political system rather than sound tax policy.
California Governor-elect Xavier Becerra has signaled plans to reverse recent Medi-Cal restrictions that removed tens of thousands of undocumented immigrants from the program after outgoing Gov. Gavin Newsom rolled back coverage expansions amid budget shortfalls and higher-than-expected healthcare costs. Becerra, who takes office facing a tight state budget, deeper federal healthcare cuts, and rising costs, has not detailed how he would fund restored coverage but says affordability of healthcare, including for undocumented residents, aligns with his fiscal and policy values. He has also floated new revenue ideas, including taxing corporations whose low-wage workers qualify for public benefits, that could indirectly affect state Medicaid financing. Specifics on timing and funding mechanisms remain undefined as Becerra prepares to take office.
At Becker's Nov. 3 CEO + CFO Roundtable panel, leaders from UCSF Health, Sutter Health, Adventist Health and Northwest Permanente described balancing outpatient expansion with rising inpatient complexity. Strategies ranged from UCSF's focus on complex, high-acuity care and recent community hospital acquisitions, to Sutter's ambulatory buildout and proposed combination with Allina Health, to Kaiser's hospital-at-home program and Risant Health value-based care expansion. Adventist Health CEO Kerry Heinrich said his system has paused capital planning due to HR 1, citing estimates that 20% to 30% of the Medicaid population in Los Angeles could lose coverage. Heinrich also flagged behavioral health and substance use patients who crowd emergency departments for lack of social support systems.
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