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InsuretheUninsuredProject10-10-2017
TotalPopulation1 39.4millionUninsuredPre-AffordableCareAct(ACA)–20132 17.9%UninsuredPost-ACA–20163 7.1%Medi-CalEnrollment1PercentofStateResidentsEnrolledinMedi-Cal
13.5million
34%Medi-CalManagedCareModelsandEnrollmentinCalifornia4
Two-PlanModel–7.0millionCountyOrganizedHealthSystems–2.2million
GeographicManagedCare–1.2millionRegionalModel–302,079
ImperialandSanBenitoModel–84,622Medi-CalAdultACAExpansion1 3.7million
Medi-CalAdultACAExpansionPercentofTotalPopulation1
9.5%
CoveredCaliforniaEnrollment5 1.3million
CoveredCaliforniaEnrollmentasaPercentofTotalPopulation
3.2%
HealthPlansinCoveredCaliforniaandEnrollment–20176
AnthemBlueCrossofCalifornia*–308,740BlueShieldofCalifornia–389,710
ChineseCommunityHealthPlan–11,820HealthNet–142,630
KaiserPermanente–297,320L.A.CareHealthPlan–10,400MolinaHealthcare–67,520OscarHealthPlan–1,810SharpHealthPlan–19,560UnitedHealthcare–1,080ValleyHealthPlan–3,360
WesternHealthAdvantage–7,180
*AnthemBlueCrossexitedmostregionsintheCoveredCAMarketin2018
Medi-Cal2020Waiver:WholePersonCareCounties/Projects
AlamedaCountyHealthCareServicesAgencyCityofSacramento
ContraCostaHealthServicesCountyofMarin,DeptofHealthandHumanServices
CountyofOrange,HealthCareAgencyCountyofSanDiego,Health&HumanServicesAgency
CountyofSantaCruz,HealthServicesAgencyCountyofSonoma,DeptofHealthServices
KernMedicalCenterKingsCountyHumanServicesAgency
LosAngelesCountyDeptofHealthServicesMendocinoCountyHealthandHumanServicesAgency
MontereyCountyHealthDeptNapaCounty
InsuretheUninsuredProject10-10-2017
Medi-Cal2020Waiver:WholePersonCareCounties/ProjectsCont.
PlacerCounty,HealthandHumanServicesDeptRiversideUniversityHealthSystem–BehavioralHealthSanBernardinoCnty–ArrowheadRegionalMedCntr
SanFranciscoDeptofPublicHealthSanJoaquinCountyHealthCareServicesAgency
SanMateoCountyHealthSystemSantaClaraValleyHealthandHospitalSystemSmallCountyWholePersonCareCollaborative
ShastaCountyHealthandHumanServicesAgencySolanoCountyHealthandSocialServices
VenturaCountyHealthCareAgencyMedi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystem
SanMateo–2/1/17LiveDateRiverside–2/1/17LiveDateMarin–4/1/17LiveDate
SantaClara–6/15/17LiveDateContraCosta–6/30/17LiveDateSanFrancisco–7/1/17LiveDate
LiveDatePending:
SantaCruz,Napa,Monterey,Ventura,SanLuisObispo,Alameda,Sonoma,Kern,Orange,Yolo,Imperial,SanBernardino,SantaBarbara,SanBenito,Placer,Fresno,
SanDiego,Merced,Sacramento
LiveDatePending–PartnershipRegionalModel:Humboldt,Lassen,Mendocino,Modoc,Shasta,
Siskiyou,Solano,Trinity1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:StateandNationalEstimates,2013.Availableat:http://familiesusa.org/sites/default/files/documents/enroll-america/Enroll%20America%20State%20and%20National%20%20Uninsured%20Rate%20Estimates_%202013-2016.xlsx3RobinA.Cohen,EmilyP.Zammitti,andMichaelE.Martinez,“HealthInsuranceCoverage:EarlyReleaseofEstimatesFromtheNationalHealthInterviewSurvey,2016,”May2017,https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201705.pdf.4DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.July2017.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx5CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/6CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/
AlamedaContraCosta Marin
SanFrancisco SanMateo SantaClara
TotalCountyPopulation1
1,637,712 1,129,894 263,257 871,185 768,122 1,930,215
UninsuredPre-AffordableCareAct(ACA)—20132
14% 12% 9% 12% 11% 12%
UninsuredPost-ACA–20163
5% 4% 3% 5% 4% 4%
IndigentCareModel4 ProviderCounty
ProviderCounty
CountyMedicalServicesProgram
ProviderCounty
ProviderCounty
ProviderCounty
Medi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal
437,981
26.7%
277,046
24.5%
45,810
17.4%
224,947
25.8%
155,776
20.3%
446,988
23.2%
Medi-CalManagedCareModels5
TwoPlan TwoPlan CountyOrganized
HealthSystem(COHS)
TwoPlan COHS TwoPlan
Medi-CalManagedCareEnrollmentbyPlan6
AlamedaAllianceforHealth258,357
AnthemBlueCross62,924
ContraCostaHealthPlan183,195
AnthemBlueCross28,941
PartnershipHealthPlanofCalifornia37,582
SanFranciscoHealthPlan135,377
AnthemBlueCross20,882
HealthPlanofSanMateo113,309
SantaClaraFamilyHealth271,410
AnthemBlueCross76,786
Medi-CalAdultACAExpansion1
129,161 74,730 14,993 79,793 49,740 138,903
Medi-CalAdultACAExpansionPercentofTotalPopulation1
7.9% 6.6% 5.7% 9.2% 6.5% 7.2%
CoveredCaliforniaEnrollment7
58,710 37,040 11,740 34,650 23,100 55,910
CoveredCaliforniaEnrollmentasaPercentofTotalPopulation
3.6% 3.3% 4.5% 4.0% 3.0% 3.0%
InsuretheUninsuredProject11-15-17
Alameda
ContraCosta Marin
SanFrancisco SanMateo SantaClara
CoveredCaliforniaHealthPlanEnrollment7*AnthemBlueCrossexitedthisCoveredCaliforniaMarketin2018
*AnthemBlueCross5,990
BlueShieldofCalifornia21,750
KaiserPermanente
30,970
*AnthemBlueCross1,410
BlueShieldofCalifornia14,230
HealthNet480
KaiserPermanente
20,920
*AnthemBlueCross2,300BlueShieldofCalifornia2,760
HealthNet200
KaiserPermanente
5,490
WesternHealth
Advantage1,000
*AnthemBlueCross2,950
BlueShieldofCalifornia10,420
ChineseCommunityHealthPlan(CCHP)9,510
HealthNet340
KaiserPermanente
11,420
*AnthemBlueCross3,770
BlueShieldofCalifornia3,990
CCHP2,310
HealthNet620
KaiserPermanente
12,410
AnthemBlueCross24,260
BlueShield6,740
HealthNet990
KaiserPermanente
20,570
ValleyHealthPlan3,350
Medi-Cal2020Waiver:WholePersonCareCounties/Projects
Estimated5-Year
BeneficiaryCount:20,000
Estimated5-Year
BeneficiaryCount:52,500
Estimated5-Year
BeneficiaryCount:3,516
Estimated5-Year
BeneficiaryCount:16,954
Estimated5-Year
BeneficiaryCount:5,000
Estimated5-Year
BeneficiaryCount:10,000
Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystemCounties
LiveDatePending
06/30/2017 04/01/2017 07/01/2017 02/01/2017 06/15/2017
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2013.Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf 3EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2016.Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/
InsuretheUninsuredProject09-07-17
SanBenitoSanLuisObispo
SantaBarbara SantaCruz Monterey Ventura
TotalCountyPopulation1
58,014 278,917 448,353 276,249 441,129 854,383
UninsuredPre-AffordableCareAct(ACA)—20132
19% 15% 18% 15% 21% 15%
UninsuredPost-ACA—20163
6% 5% 8% 5% 9% 5%
IndigentCareModel4 CountyMedicalServicesProgram
Payer Hybrid Hybrid Provider Provider
Medi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal
19,031
32.8%
62,149
22.3%
146,897
32.8%
79,596
28.8%
183,225
41.5%
240,926
28.2%
Medi-CalManagedCareModel5
SanBenito CountyOrganized
HealthSystem(COHS)
COHS COHS COHS COHS
Medi-CalManagedCareEnrollmentbyPlan6
AnthemBlueCross8,099
CenCal55,487
CenCal121,953
CentralCaliforniaAllianceforHealth69,505
CentralCaliforniaAllianceforHealth154,340
GoldCoastHealthPlan207,186
Medi-CalAdultACAExpansion1
4,802 18,723 34,806 23,565 38,301 67,250
Medi-CalAdultACAExpansionPercentofTotalPopulation1
8.3% 6.7% 7.8% 8.5% 8.7% 7.9%
CoveredCaliforniaEnrollment7
1,490 12,150 15,600 12,800 12,800 33,060
CoveredCaliforniaEnrollmentasaPercentofTotalPopulation
2.6% 4.4% 3.5% 4.6% 2.9% 3.9%
InsuretheUninsuredProject09-07-17
SanBenitoSanLuisObispo
SantaBarbara SantaCruz Monterey Ventura
CoveredCaliforniaHealthPlanEnrollment7
*AnthemBlueCrossexitedtheCoveredCaliforniaMarketinthisregionin2018.
AnthemBlueCross*920
BlueShieldofCalifornia
530
UnitedHealthcare
40
AnthemBlueCross*4,310
BlueShieldofCalifornia7,750
UnitedHealthcare
90
AnthemBlueCross*8,860
BlueShieldofCalifornia6,690
UnitedHealthcare
50
AnthemBlueCross*4,090
BlueShieldofCalifornia7,440
HealthNet1,140
KaiserPermanente
10
UnitedHealthcare
130
AnthemBlueCross*11,720
BlueShieldofCalifornia
910
UnitedHealthcare
160
AnthemBlueCross*10,070
BlueShieldofCalifornia16,470
KaiserPermanente
6,320
UnitedHealthcare
190
Medi-Cal2020Waiver:WholePersonCareCounties/Projects
SanBenito,Mariposaand
Plumas
Estimated5-Year
BeneficiaryCount427
Estimated5-Year
BeneficiaryCount1,000
Estimated5-Year
BeneficiaryCount500
Estimated5-Year
BeneficiaryCount2,280
Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystem
LiveDatePending
LiveDatePending
LiveDatePending
LiveDatePending
LiveDatePending
LiveDatePending
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2013.(Non-elderlyadults)Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf 3EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2016.(Non-elderlyadults)Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2017.Availableat:http://hbex.coveredca.com/data-research/8CoveredCalifornia.ActiveSubscribersasofDecember2017.Availableat:http://hbex.coveredca.com/data-research/
InsuretheUninsuredProject11-02-17
Fresno Kern Kings Madera Merced
SanJoaquin Stanislaus Tulare
TotalCountyPopulation1
989,183 888,994 149,407 155,693 272,610 738,873 545,008 468,235
UninsuredPre-AffordableCareAct(ACA)-20132
23% 22% 23% 22% 24% 20% 21% 24%
UninsuredPost-ACA–20163
9% 9% 8% 10% 8% 7% 7% 10%
IndigentCareModel4
PayerCounty
ProviderCounty
CountyMedicalServicesProgram(CMSP)
CMSP PayerCounty
ProviderCounty
HybridCounty
HybridCounty
Medi-CalEnrollment1
PercentofCountyResidentsEnrolledinMedi-Cal
494,974
50%
411,389
46%
56,600
38%
70,038
45%
139,773
51%
300,739
41%
245,437
45%
258,523
55%
Medi-CalManagedCareModels5
TwoPlan TwoPlan TwoPlan TwoPlan CountyOrganizedHealthSystem(COHS)
TwoPlan TwoPlan TwoPlan
Medi-CalManagedCareEnrollmentbyPlan6
CalVivaHealth297,551
AnthemBlueCross111,686
KernFamilyHealth239,342
HealthNet78,873
CalVivaHealth25,760
AnthemBlueCross19,385
CalVivaHealth35,214
AnthemBlueCross19,224
CentralCaliforniaAllianceforHealth126,161
HealthPlanofSanJoaquin217,331
HealthNet25,009
HealthPlanofSanJoaquin122,039
HealthNet75,185
AnthemBlueCross94,256
HealthNet111,570
Medi-CalAdultACAExpansion1
120,303 98,159 13,410 15,328 33,234 75,025 64,410 56,599
Medi-CalAdultACAExpansionPercentofTotalPopulation1
12.2% 11.0% 9.0% 9.8% 12.2% 10.2% 11.8% 12.1%
CoveredCaliforniaEnrollment7
22,320 16,220 2,270 4,050 9,180 22,350 16,770 10,270
InsuretheUninsuredProject11-02-17
Fresno Kern Kings Madera Merced
SanJoaquin Stanislaus Tulare
CoveredCaliforniaEnrollmentasaPercentofTotalPopulation
2.25% 1.82% 1.52% 2.60% 3.37% 3.02% 3.08% 2.19%
CoveredCaliforniaHealthPlanEnrollment7*AnthemBlueCrossexitedthisCoveredCaliforniamarketin2018
*AnthemBlueCross6,660
BlueShieldofCalifornia
9,450
HealthNet20
KaiserPermanente
5,950
UnitedHealthcare
240
*AnthemBlueCross4,880
BlueShieldofCalifornia
8,370
HealthNet380
KaiserPermanente
2,590
*AnthemBlueCross
730
BlueShieldofCalifornia
1,380
KaiserPermanente
140
UnitedHealthcare
20
*AnthemBlueCross1,150
BlueShieldofCalifornia
1,820
KaiserPermanente
1,040
UnitedHealthcare
40
AnthemBlueCross8,450
BlueShieldofCalifornia
700
HealthNet30
AnthemBlueCross11,630
BlueShieldofCalifornia
1,760
HealthNet60
KaiserPermanente
8,890
AnthemBlueCross9,690
BlueShieldofCalifornia
1,500
HealthNet70
KaiserPermanente
5,510
AnthemBlueCross9,510
BlueShieldofCalifornia
560
HealthNet130
KaiserPermanente
70
Medi-Cal2020Waiver:WholePersonCarePilot
Notparticipating
Estimated5-Year
BeneficiaryCount:2,000
Estimated5-Year
BeneficiaryCount:790
Notparticipating
Notparticipating
Estimated5-Year
BeneficiaryCount:2,255
Notparticipating
Notparticipating
Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystem
LiveDatePending
LiveDatePending
LiveDatePending
Notparticipating
LiveDatePending
LiveDatePending
LiveDatePending
LiveDatePending
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2013.Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf3EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2016.Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/
InsuretheUninsuredProject10-05-17
Imperial SanBernardino RiversideTotalCountyPopulation1 187,157 2,147,933 2,360,727UninsuredPre-AffordableCareAct(ACA)—20132
28% 22% 20%
UninsuredPost-ACA—20163 12% 7% 7%IndigentCareModel4 CountyMedical
ServicesProgramProvider Provider
Medi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal
94,150
50.3%
882,666
41.1%
846,343
35.9%
Medi-CalManagedCareModels5 Imperial Two-Plan Two-PlanMedi-CalManagedCareEnrollmentbyPlan6
MolinaHealthcare15,972
CAHealth&Wellness58,847
InlandEmpireHealthPlan620,286
MolinaHealthcare80,104
InlandEmpireHealthPlan603,240
MolinaHealthcare90,2888
Medi-CalAdultACAExpansion1 22,165 231,114 211,834
Medi-CalAdultACAExpansionPercentofTotalPopulation1
11.8% 10.8% 9%
CoveredCaliforniaEnrollment7 7,830 51,300 62,460CoveredCaliforniaEnrollmentasaPercentageofTotalPopulation
4.1% 2.4% 2.6%
CoveredCaliforniaHealthPlanEnrollment8*AnthemBlueCrossexitedthisCoveredCaliforniaMarketin2018
*AnthemBlueCross1,470
BlueShield1,110
KaiserPermanente30
MolinaHealthcare5,190
UnitedHealthcare30
*AnthemBlueCross3,750
BlueShield16,460
HealthNet10,950
KaiserPermanente10,240
MolinaHealthcare9,910
*AnthemBlueCross6,220
BlueShield20,920
HealthNet12,490
KaiserPermanente11,490
MolinaHealthcare11,340
Medi-Cal2020Waiver:WholePersonCareCounties/Projects
Estimated5-YearBeneficiaryCount2,000
Estimated5-YearBeneficiaryCount38,000
Medi-Cal2020Waiver:DrugMedi-Cal—OrganizedDeliverySystem
LiveDatePending LiveDatePending LiveDate:February1,2017
InsuretheUninsuredProject10-05-17
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2013.(Non-elderlyadults)Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf3EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2016.(Non-elderlyadults)Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/8CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/
Insure the Uninsured Project 10-‐10-‐2017
Total Population1
10,229,245
Uninsured Pre-‐ Affordable Care Act (ACA)—20132
21%
Uninsured Pre-‐ Affordable Care Act (ACA)—20163
7%
Indigent Care Model4 Provider
Medi-‐Cal Enrollment1 Percent of County Residents Enrolled in Medi-‐Cal
3,980,427
39%
Medi-‐Cal Managed Care Model5 Two-‐Plan Model
Medi-‐Cal Managed Care Enrollment by Plan6 L.A. Care – 1,944,949 Health Net – 985,893
Medi-‐Cal Adult ACA Expansion1 1,160,738
Medi-‐Cal Adult ACA Expansion Percent of Total Population1 11.3% Covered California Enrollment7 335,050
Covered California Enrollment as a Percentage of Total Population
3.3%
Covered California Health Plan Enrollment7
*Anthem Blue Cross exited the Los Angeles Covered California Market in 2018
Anthem Blue Cross of California* 53,800
Blue Shield of California
118,110
Health Net 74,080
Kaiser Permanente
49,200
L.A. Care Health Plan 10,390
Molina Healthcare
27,870
Oscar Health Plan 1,600
Medi-‐Cal 2020 Waiver: Whole Person Care Counties / Projects
Estimated 5-‐year Beneficiary Count 154,044
Medi-‐Cal 2020 Waiver: Drug Medi-‐Cal – Organized Delivery System Counties
Live Date -‐ July 1, 2017
Insure the Uninsured Project 10-‐10-‐2017
1 California Department of Health Care Services. Medi-‐Cal’s Optional Adult ACA Expansion Population – October 2016. Released March, 2017. Available at http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf 2 Enroll America. Uninsured rates for Non-‐elderly Adults: All Counties in California, 2013. Available at: https://s3.amazonaws.com/assets.enrollamerica.org/wp-‐content/uploads/2015/11/CA-‐State-‐Snapshot-‐County-‐table.pdf 3 Enroll America. Uninsured rates for Non-‐elderly Adults: All Counties in California, 2016. Available at https://s3.amazonaws.com/assets.enrollamerica.org/wp-‐content/uploads/2016/11/18133102/CA_CountyData_2016.pdf 4 Provider counties offer health care services to eligible low-‐income persons through county-‐owned / operated hospitals and clinics consistent with each county’s indigent care program rules. Payer counties contract with and/or reimburse providers in the community pursuant to indigent care program rules developed by each county. Hybrid counties operate county clinics and contract with / reimburse private hospitals and providers. Thirty-‐six smaller counties contract with the County Medical Services Program to administer health care services for low-‐income individuals pursuant to CMSP program rules set by participating counties. 5Department of Health Care Services. Medi-‐Cal Managed Care Health Plan Directory. Available at http://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx 6Department of Health Care Services. Total Certified Medi-‐Cal eligibles; managed care enrollees by plan. October 2016. Available online at: http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx 7 Covered California. Active Subscribers as of September 2017. Available at: http://hbex.coveredca.com/data-‐research/
InsuretheUninsuredProject8-26-17
ElDorado Napa Placer Sacramento Solano Sonoma Yolo
TotalCountyPopulation1
184,180 142,269 376,092 1,506,677 434,102 503,953 216,866
UninsuredPre-AffordableCareAct(ACA)–20132
12% 14% 10% 17% 14% 14% 16%
UninsuredPost-ACA–20163
4% 5% 3% 6% 4% 5% 5%
IndigentCareModel4
CountyMedicalServicesProgram(CMSP)
CMSP HybridCounty
Hybrid CMSP CMSP CMSP
Medi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal
38,569
20.9%
32,683
23.0%
63,730
16.9%
558,168
37.0%
124,882
28.8%
127,856
25.4%
59,487
27.4%
Medi-CalManagedCareModels5
Regional
CountyOrganizedHealthSystem(COHS)
Regional GeographicManagedCare
(GMC)
COHS COHS COHS
Medi-CalManagedCareEnrollmentbyEnrollment6
AnthemBlueCross8,827
CAHealthand
Wellness19,387
KaiserPermanente
1,615
PartnershipHealthPlan28,788
AnthemBlueCross31,278
CAHealthand
Wellness9,919
KaiserPermanente
5,849
AnthemBlueCross
177,524
HealthNet121,420
KaiserPermanente
81,054
Molina60,426
PartnershipHealthPlan
ofCA112,898
PartnershipHealthPlan
ofCA111,488
PartnershipHealthPlan
ofCA53,138
Medi-CalAdultACAExpansion1
12,909 8,724 18,230 143,307 34,475 36,508 16,892
Medi-CalAdultACAExpansionPercentofTotalPopulation1
7.0% 6.1% 4.8% 9.5% 7.9% 7.2% 7.8%
CoveredCaliforniaEnrollment7
7,950 4,970 13,740 41,910 10,540 20,870 5,510
CoveredCaliforniaEnrollmentasaPercentofTotalPopulation
4.3%
3.5% 3.7% 2.8% 2.4% 4.1% 2.5%
InsuretheUninsuredProject8-26-17
ElDorado Napa Placer Sacramento Solano Sonoma Yolo
CoveredCaliforniaHealthPlanEnrollment8*AnthemBlueCrossexitedtheCoveredCaliforniaMarketinthisregionin2018.
AnthemBlueCross*3,510
BlueShield2,090
HealthNet20
KaiserPermanente
2,110
WesternHealth
Advantage220
AnthemBlueCross*950
BlueShield1,010
HealthNet40
KaiserPermanente
2,440
WesternHealth
Advantage540
AnthemBlueCross*3,600
BlueShield4,020
HealthNet10
KaiserPermanente
5,730
WesternHealth
Advantage370
AnthemBlueCross*9,810
BlueShield6,690
HealthNet140
KaiserPermanente
23,940
WesternHealth
Advantage1,330
AnthemBlueCross*1,370
BlueShield1,010
HealthNet90
KaiserPermanente
7,190
WesternHealth
Advantage890
AnthemBlueCross*3,310
BlueShield4,750
HealthNet120
KaiserPermanente
10,190
WesternHealth
Advantage2,500
AnthemBlueCross*1,790
BlueShield1,270
HealthNet20
KaiserPermanente
2,100
WesternHealth
Advantage320
Medi-Cal2020Waiver:WholePersonCareCounties/Projects
Estimated5-Year
BeneficiaryCount800
Estimated5-Year
BeneficiaryCount450
Estimated5-Year
BeneficiaryCount4,386
Estimated5-Year
BeneficiaryCount250
Estimated5-Year
BeneficiaryCount3,040
Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystemCounties
LiveDatePending
LiveDatePending
LiveDatePending
LiveDatePending
LiveDatePending
PartnershipRegionalModel
LiveDatePending
LiveDatePending
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableatwww.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2013.(Non-elderlyadults)Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf3EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2016.(Non-elderlyadults)Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/8CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/
InsuretheUninsuredProject11-1-17
Butte Colusa DelNorte Glenn Humboldt LakeTotalCountyPopulation1
225,125 22,408 27,040 29,073 136,086 65,128
UninsuredPre-AffordableCareAct(ACA)—20132
21% 22% 21% 22% 22% 22%
UninsuredPost-ACA—20163
7% 11% 10% 10% 7% 9%
IndigentCareModel4 CountyMedicalServicesProgram(CMSP)
CMSP CMSP CMSP CMSP CMSP
Medi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal
82,672
36.7%
9,136
40.8%
11,970
44.3%
12,300
42.3%
54,899
40.3%
31,865
48.9%
Medi-CalManagedCareModels5
RegionalModel
RegionalModel
COHS RegionalModel
COHS COHS
Medi-CalManagedCareEnrollmentbyPlan6
AnthemBlueCross30,778
CAHealth&Wellness34,438
AnthemBlueCross4,624
CAHealth&Wellness2,397
PartnershipHealthPlanof
CA11,195
AnthemBlueCross4,237
CAHealth&Wellness5,515
PartnershipHealthPlanof
CA51,693
PartnershipHealthPlanof
CA29,554
Medi-CalAdultACAExpansion1
24,813 1,805 3,079 2,774 19,000 8,992
Medi-CalAdultACAExpansionPercentofTotalPopulation1
11% 8.1% 11.4% 9.5% 14% 13.8%
CoveredCaliforniaEnrollment7
6,780 890 600 890 5,740 1,970
CoveredCaliforniaEnrollmentasaPercentofTotalPopulation
3.0% 4.0% 2.2% 3.1% 4.2% 3.0%
CoveredCaliforniaHealthPlanEnrollment7
AnthemBlueCross5,670
BlueShieldofCalifornia1,100
AnthemBlueCross760
BlueShieldofCalifornia
130
AnthemBlueCross530
BlueShieldofCalifornia
80
AnthemBlueCross820
BlueShieldofCalifornia
70
AnthemBlueCross5,050
BlueShieldofCalifornia
690
AnthemBlueCross1,540
BlueShieldofCalifornia
420
InsuretheUninsuredProject11-1-17
Butte Colusa DelNorte Glenn Humboldt LakeUnitedHealth
Care20
UnitedHealthCare10
Medi-Cal2020Waiver:WholePersonCareCounties/Projects
NotParticipating
NotParticipating
NotParticipating
NotParticipating
NotParticipating
NotParticipating
Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystemCounties
NotParticipating
NotParticipating
NotParticipating
NotParticipating
LiveDatePending
PartnershipRegionalModel
NotParticipating
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2013.Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf 3EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2016.Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/
InsuretheUninsuredProject11-1-17
Lassen Mendocino Modoc Nevada Plumas ShastaTotalCountyPopulation1
30,645 88,995 N/A 98,552 19,494 178,208
UninsuredPre-AffordableCareAct(ACA)—20132
15% 21% 19% 15% 18% 19%
UninsuredPost-ACA—20163
6% 9% 9% 4% 6% 7%
IndigentCareModel4 CMSP CMSP CMSP CMSP CMSP CMSP
Medi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal
7,835
25.6%
40,670
45.7%
N/A
N/A
25,478
25.9%
6,223
31.9%
64,607
36.3%
Medi-CalManagedCareModels5
COHS COHS COHS RegionalModel
RegionalModel
COHS
Medi-CalManagedCareEnrollmentbyPlan6
PartnershipHealthPlanof
CA7,214
PartnershipHealthPlanof
CA36,538
PartnershipHealthPlanof
CA3,011
AnthemBlueCross12,844
CAHealth&Wellness7,775
AnthemBlueCross2,518
CAHealth&Wellness2,217
PartnershipHealthPlanof
CA
60,244
Medi-CalAdultACAExpansion1
2,031 12,441 N/A 8,480 2,046 17,305
Medi-CalAdultACAExpansionPercentofTotalPopulation1
6.6% 14% N/A 8.6% 10.5% 9.7%
CoveredCaliforniaEnrollment7
460 4,050 220 6,390 840 6,930
CoveredCaliforniaEnrollmentasaPercentofTotalPopulation
1.5% 4.6% N/A 6.5% 4.3% 3.9%
InsuretheUninsuredProject11-1-17
Lassen Mendocino Modoc Nevada Plumas ShastaCoveredCaliforniaHealthPlanEnrollment7
AnthemBlueCross410
BlueShieldofCalifornia
40
AnthemBlueCross3,240
BlueShieldofCalifornia
800
UnitedHealthCare20
AnthemBlueCross190
BlueShieldofCalifornia
30
AnthemBlueCross4,920
BlueShieldofCalifornia1,450
HealthNet10
UnitedHealthCare10
AnthemBlueCross720
BlueShield120
AnthemBlueCross6,130
BlueShield800
Medi-Cal2020Waiver:WholePersonCareCounties/Projects
NotParticipating
Estimated5-Year
BeneficiaryCount600
NotParticipating
NotParticipating
Estimated5-Year
BeneficiaryCount427
CollaborativewithMariposaandSanBenito
Counties
Estimated5-Year
BeneficiaryCount600
Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystemCounties
LifeDatePending
PartnershipRegionalModel
LifeDatePending
PartnershipRegionalModel
LifeDatePending
PartnershipRegionalModel
LiveDatePending
NotParticipating
LifeDatePending
PartnershipRegionalModel
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2013.Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf 3EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2016.Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Cal4ligible;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/
InsuretheUninsuredProject11-1-17
Sierra Siskiyou Sutter Tehama Trinity YubaTotalCountyPopulation1
N/A 44,372 98,191 64,098 13,482 76,129
UninsuredPre-AffordableCareAct(ACA)—20132
17% 20% 20% 22% 21% 22%
UninsuredPost-ACA—20163
6% 8% 8% 8% 6% 7%
IndigentCareModel4 CMSP CMSP CMSP CMSP CMSP CMSP
Medi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal
N/A
N/A
18,740
42.2%
42,461
43.2%
27,237
42.5%
5,028
37.3%
32,462
42.6%
Medi-CalManagedCareModels
RegionalModel
COHS RegionalModel
RegionalModel
COHS RegionalModel
Medi-CalManagedCareEnrollmentbyPlan6
AnthemBlueCross350
CAHealth&Wellness
214
PartnershipHealthPlanof
CA17,493
AnthemBlueCross22,086
CAHealth&Wellness10,928
AnthemBlueCross9,546
CAHealth&Wellness10,953
PartnershipHealthPlanof
CA4,585
AnthemBlueCross15,930
CAHealth&Wellness8,907
Medi-CalAdultACAExpansion1
N/A 5,277 10,503 6,304 1,732 7,745
Medi-CalAdultACAExpansionPercentofTotalPopulation1
N/A 11.9% 10.7% 9.8% 12.8% 10.2%
CoveredCaliforniaEnrollment7
110 1,460 3,610 1,900 560 1,590
CoveredCaliforniaEnrollmentasaPercentofTotalPopulation
N/A 3.3% 3.7% 3.0% 4.2% 2.1%
CoveredCaliforniaHealthPlanEnrollment7
AnthemBlueCross90
BlueShieldofCalifornia
20
AnthemBlueCross1,280
BlueShieldofCalifornia
180
AnthemBlueCross2,540
BlueShieldofCalifornia1,020
KaiserPermanente
50
AnthemBlueCross1,680
BlueShieldofCalifornia
220
AnthemBlueCross490
BlueShieldofCalifornia
70
AnthemBlueCross1,120
BlueShieldofCalifornia
330
KaiserPermanente
140
InsuretheUninsuredProject11-1-17
Sierra Siskiyou Sutter Tehama Trinity YubaMedi-Cal2020Waiver:WholePersonCareCounties/Projects
NotParticipating
NotParticipating
NotParticipating
NotParticipating
NotParticipating
NotParticipating
Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystemCounties
NotParticipating
LifeDatePending
PartnershipRegionalModel
NotParticipating
NotParticipating
LifeDatePending
PartnershipRegionalModel
NotParticipating
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2013.Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf 3EnrollAmerica.UninsuredratesforNon-elderlyAdults:AllCountiesinCalifornia,2016.Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/
InsuretheUninsuredProject09-06-17
TotalCountyPopulation1 3,181,371UninsuredPre-AffordableCareAct(ACA)—20132 15%UninsuredPost-ACA—20163 5%IndigentCareModel4 PayerCountyMedi-CalEnrollment6
PercentofCountyResidentsEnrolledinMedi-Cal
910,429
28.6%Medi-CalManagedCareModel5 CountyOrganizedHealthSystem(COHS)Medi-CalManagedCareEnrollmentbyPlan6 CalOptima
772,502Medi-CalAdultACAExpansion1 262,837Medi-CalAdultACAExpansionPercentofTotalPopulation1 8.3%CoveredCaliforniaEnrollment7 124,740CoveredCaliforniaEnrollmentasaPercentofTotalPopulation 3.9%CoveredCaliforniaHealthPlanEnrollment8
*AnthemBlueCrossexitedtheOrangeCountyCoveredCaliforniaMarketin2018
*AnthemBlueCross33,340
BlueShieldofCalifornia53,040
HealthNet22,500
KaiserPermanente15,660
OscarHealthPlan210
Medi-Cal2020Waiver:WholePersonCareCounties/Projects Estimated5-YearBeneficiaryCount9,303
Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystem
LiveDatePending
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2013.(Non-elderlyadults)Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf3EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2016.(Non-elderlyadults)Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/8CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/
InsuretheUninsuredProject9-6-2017
TotalCountyPopulation1 3,300,891UninsuredPre-AffordableCareAct(ACA)-in20132 17%UninsuredPost-ACAin20163 5%IndigentCareModel4 PayerMedi-CalEnrollment1PercentofCountyResidentsEnrolledinMedi-Cal
907,970
27.5%Medi-CalManagedCareModel5 GeographicManagedCareMedi-CalManagedCareEnrollmentbyPlan6 Care1stHealthPlan
82,187
CommunityHealthGroup284,335
HealthNet75,654
KaiserPermanente52,513
MolinaHealthcare225,246
Medi-CalAdultACAExpansion1 267,055Medi-CalAdultACAExpansionPopulationasaPercentofTotalPopulation1
8.1%
CoveredCaliforniaEnrollment7 108,510CoveredCaliforniaEnrollmentasaPercentofTotalPopulation 3.3%CoveredCaliforniaHealthPlanEnrollment8
*AnthemBlueCrossexitedtheSanDiegoCoveredCAMarketin2018
AnthemBlueCrossofCalifornia9,240*
BlueShieldofCalifornia24,700
HealthNet17,660
KaiserPermanente24,140
MolinaHealthcare13,200
SharpHealthPlan19,560
Medi-Cal2020Waiver:WholePersonCarePilot Estimated5-YearBeneficiaryCount
1,049
Medi-Cal2020Waiver:DrugMedi-Cal–OrganizedDeliverySystem
LiveDatePending
InsuretheUninsuredProject9-6-2017
1CaliforniaDepartmentofHealthCareServices.Medi-Cal’sOptionalAdultACAExpansionPopulation–October2016.ReleasedMarch,2017.Availableathttp://www.dhcs.ca.gov/dataandstats/statistics/Documents/Expansion_Adults_201610_ADA.pdf2EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2013.(Non-elderlyadults)Availableat:https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2015/11/CA-State-Snapshot-County-table.pdf3EnrollAmerica.Uninsuredrates:AllCountiesinCalifornia,2016.(Non-elderlyadults)Availableathttps://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2016/11/18133102/CA_CountyData_2016.pdf4Providercountiesofferhealthcareservicestoeligiblelow-incomepersonsthroughcounty-owned/operatedhospitalsandclinicsconsistentwitheachcounty’sindigentcareprogramrules.Payercountiescontractwithand/orreimburseprovidersinthecommunitypursuanttoindigentcareprogramrulesdevelopedbyeachcounty.Hybridcountiesoperatecountyclinicsandcontractwith/reimburseprivatehospitalsandproviders.Thirty-sixsmallercountiescontractwiththeCountyMedicalServicesProgramtoadministerhealthcareservicesforlow-incomeindividualspursuanttoCMSPprogramrulessetbyparticipatingcounties.5DepartmentofHealthCareServices.Medi-CalManagedCareHealthPlanDirectory.Availableathttp://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx6DepartmentofHealthCareServices.TotalCertifiedMedi-Caleligibles;managedcareenrolleesbyplan.October2016.Availableonlineat:http://www.dhcs.ca.gov/dataandstats/reports/Pages/MMCDMonthlyEnrollment.aspx7CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/8CoveredCalifornia.ActiveSubscribersasofDecember2016.Availableat:http://hbex.coveredca.com/data-research/