Publicly supported programs cover about half of Californians.

• Public health insurance covers low- to moderate-income individuals, older adults, people with disabilities, members of the military or military veterans, and members of special populations such as youth aged out of foster care through age 26, and youth and adults transitioning from incarceration.
• Medi-Cal and Medicare are cornerstones of public health insurance in California, covering around half of the population. Medi-Cal—California’s Medicaid program—is a state-federal program that offers free or low-cost health coverage to 14.5 million low-income Californians as of October 2025. Medicare is a federal program that covers over 7.1 million Californians with disabilities and adults 65 and older; about 1.8 million beneficiaries were enrolled in both Medi-Cal and Medicare.
• Covered California is a marketplace for purchasing private health plans with public subsidies that 1.9 million Californians enrolled in for 2026. With the end of enhanced federal support, monthly premiums increased by $50 for low-income purchasers and by $290 for higher-income individuals. Immigrants with DACA status may no longer purchase on the exchange, and some documented immigrants will lose eligibility in 2027.

Medi-Cal, which covers over one-third of Californians, faces new constraints.

• Medi-Cal’s comprehensive coverage ranges from doctor visits, hospital stays, and prescription drugs to behavioral health services, dental care, and long-term care for seniors and people with disabilities.
• The federal government covers most of Medi-Cal’s costs. In the 2025–26 fiscal year, Medi-Cal spending is estimated to be about $197 billion, with the General Fund covering $45 billion. Costs exceeded estimates, leading the state to borrow about $3.4 billion and implement cost-saving policy changes.
• Federal changes under HR 1, along with state policy changes, will limit Medi-Cal coverage for certain immigrants. The state has frozen new enrollment for some undocumented adults in 2026.
• Starting in 2027, federal work requirements will require certain nondisabled adults without dependent young children to meet work or community engagement criteria to maintain Medi-Cal coverage.

Changes to eligibility and eligibility reviews are expected to reduce enrollment in Medi-Cal.

• As of December 2025, total enrollment in Medi-Cal had declined by 1.6 million after income eligibility reviews resumed. When reviews were suspended due to the pandemic, enrollment increased by 26% (about 3.3 million) between February 2020 and April 2023.
• Federal changes mean that eligibility reviews will increase in frequency to every six months for many adults beginning in January 2027. This is likely to reduce enrollment in Medi-Cal: 2 million individuals disenrolled when reviews resumed after the pandemic, with about two-thirds losing coverage for procedural reasons rather than ineligibility.
• For 2026, California has reinstated the Medi-Cal asset test for older adults and people with disabilities. Federal policy will limit home equity value for enrollees to $1 million beginning in 2028. California’s high real estate values mean that some individuals who are house-rich and income-poor will not qualify for Medi-Cal.
• To prevent coverage gaps, SB 260 enables Covered California to automatically enroll individuals in its lowest-cost plan when they lose Medi-Cal coverage. The policy transitioned about 112,000 individuals to Covered California in its first ten months.

Medi-Cal funds programs for high-need populations, children, and youth.

• Through the CalAIM initiative, Medi-Cal is working with nonprofits, public hospitals, counties, and tribes to address complex challenges for some Californians, including people experiencing homelessness, children in the child welfare system, and individuals transitioning from incarceration.
• Medi-Cal supports some screenings and preventive services in TK–12 schools for children and adolescents as part of its Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits.
• Through California’s Children and Youth Behavioral Health Initiative (CYBHI) schools can be reimbursed for behavioral health services delivered on campus by payers that include Medi-Cal.

Medicare is a federal health insurance program covering a growing share of Californians.

• About 93% of beneficiaries are older adults, and the number of Medicare enrollees has been growing as California’s population ages. Unlike Medi-Cal, Medicare does not cover long-term care.
• Medicare is financed through federal trust funds, payroll taxes, and enrollee premiums.
• Medicare has multiple components. Part A covers hospitalizations, with no cost-sharing for most enrollees. Part B pays for outpatient care, and Part D covers prescriptions; both require out-of-pocket payments. Medicare Advantage, or Part C, allows recipients to enroll in private plans in lieu of traditional Medicare.
• About half of California’s Medicare beneficiaries are enrolled in Medicare Advantage. Dual eligibles, who qualify for both Medicare and Medi-Cal, can enroll in a Medi-Medi plan, a type of Medicare Advantage that includes and coordinates Medicare and Medi-Cal. Medi-Medi plans will be in most counties in 2026.