The Future of Medi-Cal: Bold Ideas for the Next Decade

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Medi-Cal is the cornerstone of California’s health care system. It provides essential coverage to 15 million Californians, serves as the financial backbone for our safety net hospitals and clinics, and supports local economies across the state. For decades, this program has been a lifeline, ensuring that Californians with low incomes — including children, older adults, and people with disabilities — can get health care when they need it.

As we look toward 2026 and beyond, the environment surrounding Medi-Cal is shifting. With unprecedented federal cuts on the horizon and a changing fiscal landscape, we recognize that it’s no longer enough to protect the status quo. To ensure Medi-Cal can continue to advance health equity and provide financial security for millions, we need a vision for the program that is as resilient as the people it serves.

Recognizing the urgency and high stakes of this challenge, the California Health Care Foundation helped launch the Future of Medi-Cal Commission late last year. The commission is a 29-member independent body charged with delivering a 10-year roadmap to California’s next governor in January 2027. We know that a challenge of this scale demands the widest possible lens and that we need to look beyond the commission room to harness the collective ingenuity of the broader health care community. This is why the commission’s work will benefit from a 50-member advisory group representing consumers, providers, health plans, and many others.

Seeking Transformation, Not Tweaks

The drive for innovative thinking also led us to issue a “Call for Bold Ideas to Strengthen and Preserve Medi-Cal.” We set a high bar in this solicitation, asking applicants not to suggest incremental improvements for Medi-Cal. We requested that they look five to 10 years into the future and fundamentally reimagine how Medi-Cal should operate. We asked them to set aside the political constraints of the moment and focus on what should be possible.

The application process was structured to be as open and inclusive as possible. Submissions from diverse perspectives — researchers, practitioners, community leaders, and those with lived experience — were highly encouraged.

We invited the field to dream big. Applicants were asked to prepare a two-page concept brief outlining a transformative idea, such as a new framework for state-federal financing, a radical redesign of Medi-Cal managed care, or an innovative approach to serving enrollees with complex needs. Our goal was to identify up to five concepts and for CHCF to support each with a $50,000 grant for development into a full paper for publication.

A Wealth of Ideas

The response was overwhelming. We received 132 submissions from across California. While we could only select a small number, the collective input offers a fascinating roadmap for where respondents believe we need to go next.

Download the list of submitted concepts.*

The most common theme — appearing in nearly two dozen proposals — was payment innovation. Stakeholders see financial realignment as a prerequisite for care transformation. The concepts included a wide range of ideas, such as value-based payments to managed care plans to drive higher quality care, and establishing personal health accounts for Medi-Cal enrollees to pay for eligible health expenses.

Technology and artificial intelligence (AI) represented the second largest cluster of ideas. Eighteen proposals focused on leveraging new tools to improve access, including concepts like a statewide autopilot infrastructure for Medi-Cal preventive care. It would use AI to monitor claims data and help close preventive gaps quickly.  

We saw convergence around the need for better care coordination and a stronger workforce. Eleven proposals called for regional hubs to bridge the gap between physical and behavioral health — such as neighborhood specialty access sites to reduce inequities in specialty care. Another 11 applications focused on workforce development, proposing ideas like the “Medi-Cal Techquity Corps,” a workforce of digital navigators to support Medi-Cal members.

Beyond these top tiers, the ideas spanned the spectrum of Medi-Cal’s ecosystem. From streamlining eligibility and enrollment to universal primary care to integrating behavioral health and social services, the breadth of proposals confirmed that the appetite for innovation in California is as strong as ever.

The Selected Concepts

We are thrilled to announce that we have awarded grants to six author teams instead of the planned five. They will develop their concepts into full papers to help inform the commission’s recommendations.

Here are the winning bold ideas:

• Any Card, Any Provider: Unifying Medi-Cal’s Networks and Administration
  Naman Shah, MD, PhD, Los Angeles County Department of Public Health
  Shah proposes decoupling administrative functions from health plans so that any Medi-Cal member can see any credentialed provider. This would allow plans to compete on care quality rather than network restrictions.
• Consideration of a Medicaid Per Capita Cap
  Beth Waldman and Mary Beth Dyer, Bailit Health
  Waldman and Dyer explore a fundamental shift in financing — moving from open-ended matching funds to a per capita cap model — to potentially offer California greater policy flexibility and budget certainty in the face of federal changes.
• In-Home Supportive Services Integration into Medi-Cal Managed Care
  Athena Chapman and Gretchen Nye, Chapman Consulting
  Chapman and Nye propose full integration of In-Home Supportive Services (IHSS) into managed care to streamline access and oversight while strictly preserving consumer direction for aging members and people with disabilities.
• Multi-Payer Primary Care Payment Reform Model
  Rachel Tobey, MPA
  Tobey outlines a unified primary care payment model across Medi-Cal, CalPERS, and Covered California to standardize incentives, reduce administrative burdens, and sustain high-value, team-based care for all patients.
• Partially Unified Financing: Covered California for Most
  Rick Kronick, University of California, San Diego
  Kronick envisions moving most Californians, including those currently on Medi-Cal, into Covered California plans to create a more seamless, equitable, and continuous coverage system to reduce fragmentation.
• Toward an AI-First Medi-Cal: A Health Data Utility
  Nate Favini, MD, and Neil Batlivala, Pair Team
  Favini and Batlivala reimagine Medi-Cal as an “AI-first” system that leverages a health data utility to proactively identify social and medical risks, allowing the system to intervene before members reach the point of health crisis.

Looking Ahead

We are eager to see how these authors develop their concepts into actionable strategies. The foundation expects to publish the full papers in the spring. These publications will spark important conversations, and we hope they will serve as critical input as the Future of Medi-Cal Commission drafts its roadmap for the incoming gubernatorial administration. Thank you to everyone who submitted an idea. Your vision and energy remind us that in California the commitment to a just and effective Medi-Cal system runs deep.