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.
[1] Medi-Cal was created in 1965 by the California Medical Assistance Program a few months after the national legislation was passed.
[5] 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).
[10] Beginning in 2014 under the Patient Protection and Affordable Care Act (PPACA), those with family incomes up to 138% of the federal poverty level became eligible for Medi-Cal (pursuant to 42 U.S.C.
[13] Previously, meeting eligibility requirements other than immigration status qualified them restricted-scope Medi-Cal limited to emergency and pregnancy-related services only[14] 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.
[18] 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.
[3] In the fee-for-service arrangement, health care providers submit claims to the Medi-Cal program for services rendered.
[20] Most beneficiaries receive Medi-Cal benefits from contracted Medicaid managed care organizations (MCOs).
As of January 2018, 10.8 million people were enrolled in a Medi-Cal managed care plan, representing about 81% of all enrollees.
The program included an expansion of the patient-centered medical home primary care approach,[23] an expansion of coverage with the Low Income Health Program (LIHP), and incentive pay-for-performance to hospitals via the Delivery System Reform Incentive Pool (DSRIP).
[31] In 2005, the California Health Care Foundation recommend various steps to improve the plans, which resulted in some changes to the contracts.
[31] Medi-Cal is jointly administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS), while the county welfare department in each of the 58 counties is responsible for local administration of the Medi-Cal program.
Since 1933, California law has required counties to provide relief to the poor, including health care services and general assistance.