Medi-Cal, California’s Medicaid program, is the state’s health insurance program for Californians with low incomes, including 40% of all children, half of all people with disabilities, over a million seniors, and nearly four million adults. It also pays for more than 50% of all births in the state and 58% of all patient days in long-term care facilities. In total, 13 million, or one in three, Californians rely on the program for health coverage. Medi-Cal pays for essential primary, specialty, acute, behavioral health, and long-term care services. Spending on Medi-Cal represents 17% of the state’s General Fund spending, with total expenditures for 2018–19 of $99.2 billion.

This fact sheet describes the organization, funding sources, and process for developing the Medi-Cal program budget, including:

• Structure and component parts that make up the budget
• Process to craft the proposed budget, including legislative review
• Process for making changes to the program, including elimination or addition of a benefit or service, or changes to rates

In addition, challenges to the financing of Medi-Cal are also discussed, such as the impact of increased state matching for the expansion population under the Affordable Care Act, loss of funding under the Managed Care Organization tax, and the renegotiation of the Section 1115 waiver.