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.
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.
Last updated: Sep 22, 2026
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