Tracking ACA Implementation in California

Version 5: January 2014

This guide tracks the California implementation of the Affordable Care Act (ACA), whose provisions touch on most aspects of the health care system, including cost, quality, and access. It describes the law's requirements for public and private coverage and breaks each into implementation objectives — some complete, others underway, and some not yet begun.

The law requires, with few exceptions, that people obtain health insurance, and it provides new structures and supports to help them do so. Today about 1 in 5 nonelderly Californians is uninsured. This ratio is expected to fall to 1 in 10 by 2016 because of the ACA. Those who obtain health insurance should gain not only financial security, but also improved access to care, and through it, better health outcomes.

How to See Specific Updates 

The most current version of Tracking ACA Implementation in California is available on these web pages. For earlier versions with redlined changes, see the PDF under Document Downloads to the right.


This guide is organized by these broad ACA goals and implementation objectives:

Goal 1: Expand coverage in public programs. The law expands Medi-Cal coverage to low-income adults and children. This should improve access to care for the neediest Californians.

Goal 2: Simplify and streamline eligibility and enrollment. States must provide a means by which people can quickly learn if they are eligible for state-funded programs or subsidized private health plans, apply, and enroll.

Goal 3: Protect health insurance consumers. The law prohibits insurance companies from denying coverage based on pre-existing conditions or from placing lifetime limits on coverage, and assures that products sold meet standards for comprehensiveness.

Goal 4: Create a new marketplace for private health insurance. California's Health Benefit Exchange will make shopping for health insurance easier, make the costs and benefits of plans more understandable, and administer subsidies to qualifying applicants.

State Action & Lead, Status, and Implementation Date

For each objective, this guide provides a brief discussion and a table that enumerates the state action and lead(s), status, and implementation date. Along with the California administration and legislature, responsible state leads are:

  • The California Department of Health Care Services (DHCS)
  • The California Department of Insurance (CDI)
  • The California Department of Managed Health Care (DMHC)
  • The California Health and Human Services Agency (CHHS)
  • The California Health Benefit Exchange (CHBE, the Exchange, and Covered California)
  • The Managed Risk Medical Insurance Board (MRMIB)

See more information about these entities.

About This Guide

CHCF contracted with the management consulting firm Leading Resources Inc. (LRI) to develop content for this guide. LRI principals Eric Douglas and Karin Bloomer solicited and incorporated input from executive staff of DHCS, the Exchange, DMHC, MRMIB, and CDI. Jonah Frohlich and Alice Lam of Manatt Health Solutions; Deborah Kelch of Kelch Policy Group; and independent consultant Lesley Cummings also provided comments.

This is the fourth and final quarterly update of this guide, initially posted in November 2012. Information in this final version is complete as of January 8, 2014.

Send questions and comments about this resource to Marian Mulkey, director of CHCF's Health Reform and Public Programs Initiative.

Further Reading

See CHCF's complete library about the Affordable Care Act of 2010.