This month marks the tenth anniversary of Medi-Cal expansion under the federal Affordable Care Act (ACA). California’s embrace of the Affordable Care Act has transformed the state’s health insurance landscape: Over the past decade, the uninsured rate has fallen to historic lows and millions of people have gained health insurance. Most of these gains were driven by Medi-Cal expansion.
Medi-Cal enrollment increased by more than 7 million from 2013, when the state launched some pre-ACA initiatives such as county low-income health plans, to peak enrollment in April 2023. By far the largest increase (214%) was among adults under 65, many of whom are newly eligible for the ACA. Enrollment also increased among children (12%) and seniors (55%); while these groups were not significantly affected by the ACA, during this period state funding expanded Medi-Cal to those in these age groups. Certificate of immigration.
The federal policy response to the pandemic has also resulted in a significant increase in Medi-Cal enrollment. Under federal Medicaid rules, enrollees must undergo an annual redetermination to ensure they remain income-eligible. This process was paused during the pandemic to ensure insurance coverage. As a result, Medi-Cal enrollment increased by approximately 26% between February 2020 and April 2023, when the federal public health emergency ended and the redetermination process resumed. Enrollment has since declined; some 14.9 million people were enrolled as of October 2023 (the latest month for which data is available), a decrease of nearly 7%, and enrollment is likely to fall further by May, while all major enrollments are Enrollees who skipped redetermination during the pandemic were supposed to be redetermined annually.
As of November 2023, approximately 1.1 million people had been deregistered – the vast majority for procedural reasons such as failure to complete required paperwork. It’s hard to know how many people who were dropped would have access to other health insurance, but one study estimated that about 20 percent of people who lost Medi-Cal coverage would become uninsured once redetermination restarts. Monitoring the redetermination process helps maintain coverage gains over the past decade.
A particularly important issue is ensuring that Medi-Cal participants have access to the health care services they need. Medi-Cal’s payment rates are lower than those of other health insurance, which has long raised concerns about whether the program provides adequate care. Several recent policy initiatives have focused on this issue; most recently, AB 119 (2023) authorized a new managed care organization (MCO) tax designed to support certain providers’ increased Medi-Cal coverage in 2024 and 2025 Payout rate.
The state lacks detailed information on how many providers serve Medi-Cal enrollees, making it difficult to assess the effectiveness of these rate increases. New data sources are being developed that may help, but designing better ways to track provider participation in the Medi-Cal program should be a priority.
Under the governor’s 2024-25 budget proposal, state and federal Medi-Cal spending would exceed $150 billion, making it the largest state program to date. While the federal government covers about 70% of Medi-Cal’s costs, state general fund spending is expected to be about $35 billion this fiscal year. Despite the state’s current budget challenges, the proposed budget retains significant new state investments to expand Medi-Cal to undocumented adults. This underscores the critical role the program plays and the importance of ensuring Medi-Cal participants have access to health care providers.