Centers for Medicare & Medicaid Services

Health Insurance Coverage in California

Health Plan Overview

Insurance CompanyCenters for Medicare & Medicaid Services
StateCalifornia
Websitemedicaid.gov
Number of Hospitals in Network6
Number of Plans Offered5

Network Hospital Locations

Hospitals in Network (6)
David Grant USAF Medical CenterPioneers Memorial HospitalHealthbridge Childrens Rehab HospitalTelecare Heritage Psychiatric Health FacilityWillow Rock CenterSanta Cruz County Psychiatric Health Facility

Available Plans

Medicaid

5 plans

Plan Details
Plan NamePlan Type
Managed Medicaid plansMedicaid
Medi-Cal/MedicaidMedicaid
Medicaid MCOMedicaid
Medicaid/Medi-CalMedicaid
Private, Medicaid, MedicareMedicaid

Recent News

2025-05-12
Navigating Medi-Cal health plans in California involves understanding options like integrated Medi-Medi Plans for seniors who qualify for both Medicare and Medi-Cal. Additionally, in certain geographic areas like Sacramento and San Diego, Medi-Cal members may choose from several commercial plans available through a Geographic Managed Care model, offering more choices for finding plans that include preferred doctors.
2025-03-21
In California, individuals eligible for both Medicare and Medi-Cal are known as dual eligibles or Medi-Medis. The majority of these individuals are enrolled as full duals, having Medicare Parts A, B, and D, and full-scope Medi-Cal benefits. These full duals are eligible to enroll in Medicare Advantage plans, including Dual Eligible Special Needs Plans (D-SNPs). A recent policy change, the Part A Buy-In, effective January 1, 2025, transitioned most partial dual members to full dual status.
2025-03-19
California's Healthcare Payments Database (HPD) collects data from various payer types, including the Department of Health Care Services (DHCS) for Medi-Cal members, commercial health plans and insurers (covering employer-based, individual, and Medicare Advantage), and Centers for Medicare and Medicaid Services (CMS) for Medicare Fee-for-Service members. This database provides an overview of data completeness across these different types of health coverage in California.
2025-03-12
California has implemented an expanded tax on insurers, including both Medicaid and private plans, as a mechanism to secure federal funds for the state's Medi-Cal expansions. This expanded tax, approved by CMS in 2023, significantly increased the monthly per-enrollee fee for Medicaid insurance plans compared to private insurance plans, with scheduled increases through 2026. The state uses the revenue generated to increase Medicaid capitation rates, which is then partially reimbursed by the federal government, effectively using the tax to draw down federal funds for its growing Medi-Cal program.
2025-02-05
Effective January 1, 2025, California Senate Bill 311 designated California as a Part A buy-in state. This change means the Medi-Cal program will now pay Medicare Part A premiums for eligible individuals who were not automatically enrolled. This policy impacts partial dual eligible members, potentially making them eligible for Medicare Advantage plans, including Dual Eligible Special Needs Plans (D-SNPs), leading to a potential increase in patients with D-SNPs for healthcare providers.
2025-01-08
Recent Medicare policy changes are impacting dual eligible individuals and state operations in California, particularly concerning the rise of Dual Eligible Special Needs Plans (D-SNPs). D-SNPs, a type of Medicare Advantage plan, are becoming a primary integrated care option for states like California. These plans require contracts with both CMS and state Medicaid agencies to integrate and coordinate care for individuals eligible for both Medicare and Medi-Cal.

State Leadership

Private, Medicaid, Medicare

Director, California Department of Health Care Services

Appointed Director of the California Department of Health Care Services (DHCS) by Governor Gavin Newsom on September 10, 2021. DHCS supports the health of about 14 million Californians on Medi-Cal, the state's Medicaid program. Before her appointment to DHCS, she served as Undersecretary of the California Health and Human Services Agency (Agency) since 2018 and Deputy Secretary of the Office of Program and Fiscal Affairs at Agency from 2017 to 2018. Prior to joining Agency, she worked for the California Legislature for 13 years. [6]

Private, Medicaid, Medicare

State Medicaid Director & Chief Deputy Director for Programs, California Department of Health Care Services

Appointed state Medicaid director at the Department of Health Care Services (DHCS) effective March 25, 2024. He also serves as Chief Deputy Director for Programs. Sadwith has held leadership positions at DHCS since July 2021, most recently serving as deputy director for behavioral health since June 2022. He has led multiple reforms, programs, and funding investments to strengthen behavioral health access, quality, and service delivery for Medi-Cal members and Californians served by public programs, including behavioral health policy endeavors in the California Advancing and Innovating Medi-Cal (CalAIM) demonstration. He previously spent over seven years at the Centers for Medicare & Medicaid Services (CMS). [2, 4, 7, 10, 11]

Private, Medicaid, Medicare

Chief Deputy Director, Policy & Program Support, California Department of Health Care Services

NA

Private, Medicaid, Medicare

Deputy Director & Chief Information Officer, Enterprise Technology Services, California Department of Health Care Services

Serves as Chief IT Strategy Officer and Chief of the Information Technology Strategy Services Division within Enterprise Technology Services at DHCS. Appointed in March 2022. Instrumental in guiding department-wide IT leadership, orchestrating the development and execution of enterprise-level product modernization and architecture strategy, managing a vast portfolio of projects, and delivering comprehensive IT administrative services. [8, 11]

Private, Medicaid, Medicare

Chief Operating Officer for Programs, California Department of Health Care Services

Appointed as DHCS’ new Chief Operating Officer for Programs (COOP), effective October 16. As part of the Directorate, Chris provides leadership of Enterprise Data and Information Management, Enterprise Technology Services, and Program Operations. Chris previously served as DHCS’ Deputy Director for Enterprise Technology Services (ETS) and Chief Information Officer (CIO). [8, 11]

Private, Medicaid, Medicare

Deputy Director, Audits & Investigations, California Department of Health Care Services

NA

Private, Medicaid, Medicare

Deputy Director, Administration, California Department of Health Care Services

NA

Private, Medicaid, Medicare

Deputy Director, Office of Communications, California Department of Health Care Services

NA

Private, Medicaid, Medicare

Deputy Director, Legislative & Governmental Affairs, California Department of Health Care Services

NA

Private, Medicaid, Medicare

Deputy Director, Health Care Benefits & Eligibility, California Department of Health Care Services

NA

Private, Medicaid, Medicare

Deputy Director, Health Care Delivery Systems, California Department of Health Care Services

NA

Private, Medicaid, Medicare

Deputy Director & Chief ALJ, Office of Administrative Hearings & Appeals, California Department of Health Care Services

NA