Medi-Cal – California’s Medicaid program – provides free or reduced-cost health coverage for low income individuals and families. Medi-Cal increases patients’ access to important healthcare services, such as doctor visits, immunizations, hospital care, and the 10 essential health benefits.
Medi-Cal primarily serves individuals and families who are below 138% of the Federal Poverty Level. Others who are eligible for Medi-Cal include (but are not limited to): newborns, foster care youth, pregnant women, persons with disabilities, and seniors.
How many children are in Medi-Cal?
Medi-Cal is the largest state Medicaid program in the nation, covering nearly half the children in California. It is estimated that a total of 5.2 million youth are currently enrolled in Medi-Cal.1
Among our 8 member hospitals, Medi-Cal funds about 62% of inpatient and outpatient visits.
Unfortunately, Medi-Cal does not usually reimburse hospitals enough to cover the basic costs of providing care. This is a major concern for children’s hospitals, which provide critical – but costly – care for children with serious conditions. Although Medi-Cal does not sufficiently cover costs, it is still an important payer for children’s hospitals.
The Affordable Care Act (ACA) has expanded coverage to populations that were previously uninsured. Since the ACA was passed into law in 2010, nearly 1 million more youth have signed up for for Medi-Cal.1
Governor Jerry Brown recently announced a budget deal that will expand Medi-Cal coverage for undocumented immigrant children. Under this expansion, which is scheduled to begin in May 2016, roughly 170,000 youth will become covered.2 Although this will cost the state $132 million annually to implement, the benefits are likely to outweigh the costs. For example, there will be significant financial savings from costly – and preventable – hospitalizations in this population. Moreover, expanding Medi-Cal to all children provides them a chance to live healthier, happier, and more productive lives.
The California Department of Health Care Services is developing a
process to re-procure its Medi-Cal managed care contracts across
the state. In up to thirty-six counties,
managed care plans that are currently covering Medi-Cal enrollees
will have to compete successfully for the privilege of continuing
to serve this population. Other managed care plans,
those that are not currently covering Medi-Cal managed care
enrollees, may also submit bids. Plans that are chosen
would begin operations under new contracts with the Department in