- Medi-Cal is a public health insurance program for low-income Californians.
Medi-Cal—California’s Medicaid program—is a state-federal program that offers free or low-cost health coverage to Californians with low family incomes. Prior to the Affordable Care Act (ACA), Medi-Cal served low-income families and children, the elderly, and people with disabilities. Under the ACA, California lawmakers expanded the program to include low-income adults without children or a qualifying disability starting in 2014. Total program costs are slated to be $98.5 billion in fiscal year 2018–19, with the federal government providing $62.7 billion, the state General Fund $20.7 billion, and other state sources—including funds generated by provider fees and transfers from local governments—another $15.1 billion.
- Medi-Cal eligibility is determined by a combination of income and other factors.
To qualify for comprehensive Medi-Cal, most adults must have an annual income below about $17,250 for a single adult (138% of the federal poverty level or FPL) and satisfactory immigration status. Pregnant and postpartum women are eligible with incomes up to about $68,700 for a family of three (322% FPL), though women with incomes just under this threshold must make financial contributions. Children under age 19 are eligible if their family incomes are below about $56,750 for a family of three (266% FPL), regardless of immigration status. A more limited version of Medi-Cal covers undocumented adults in certain situations, such as medical emergency or pregnancy.
- Medi-Cal provides 12 million Californians with comprehensive health insurance.
Enrollment in comprehensive Medi-Cal has increased rapidly in recent years, growing from about 8 million at the end of 2013 to more than 12 million (31% of the state) in August 2018. The limited version of Medi-Cal covers about 900,000 low-income undocumented adults, an additional 2% of the state’s population. In some counties, about half of residents are covered by either comprehensive or limited Medi-Cal.
About half of residents in some counties are enrolled in Medi-Cal
- Families make up half of the Medi-Cal caseload but have lower costs.
Children and parents are the largest group of Medi-Cal enrollees, accounting for nearly half of the total caseload. Adults under 65 who gained eligibility under the ACA are the second-largest group (26% of enrollees), followed by seniors and people with disabilities (15%). The remainder of the caseload includes undocumented adults and other groups, such as those in foster care and long-term care. The caseload mix is a main driver of costs. The most recent data for California from 2014 indicate annual average costs per enrollee were lowest for children ($2,836) and adults under 65 ($3,913)—but significantly higher for seniors ($12,268) and individuals with disabilities ($20,222).
More than a quarter of Medi-Cal enrollees are adults who gained coverage under the ACA
- Medicaid expansion is linked to improved outcomes.
Beyond substantially increasing insurance coverage, a growing body of evidence has linked Medicaid expansion under the ACA to improved outcomes across a number of domains. Individuals in states that expanded Medicaid experienced increased access to care, greater use of prescription drugs and preventive care, and improved financial well-being, including fewer bankruptcies, better credit scores, and reduced debt relative to those in states that chose not to expand. Medicaid expansion is also associated with improved financial performance at hospitals and a lower likelihood of hospital closures, especially in rural areas.
- California’s goal of expanding coverage conflicts with federal priorities.
Medi-Cal is an essential component of California policymakers’ ongoing efforts to achieve universal health coverage. However, the federal government is encouraging states to adopt policies that could decrease coverage, such as making Medicaid subject to work requirements. Reduced federal funding also threatens several large Medi-Cal initiatives. One key project is California’s Whole Person Care pilot program, which uses federal funds to provide more-integrated health and social services for high-cost enrollees, with the goal of reducing health care costs and maintaining budget neutrality.