Sacramento Area — Regional Market Report 2026

AUTHOR: Len Finocchio, DrPH, see all

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Introduction

The Sacramento region, comprised of El Dorado, Placer, Sacramento, and Yolo Counties, is growing. Between 2019 and 2023, the four-county area added residents while California as a whole lost them, and much of that growth landed in the suburbs east and south of the capital. The region’s four large health systems have followed, opening hospitals, clinics, and medical office buildings in the communities with the most commercially insured patients.

At the same time, Medi-Cal now covers more than one in three people across the region. Two of those counties rebuilt their Medi-Cal managed care markets in 2024. Community health centers have expanded their reach even while absorbing higher labor costs and delayed payments. Specialty care remains difficult to get for patients covered by Medi-Cal, despite a physician supply that outpaces the state.

This report examines how those forces interact, drawing on interviews with regional health care leaders and the most recent available data. It is one of seven regional reports in the 2026 Regional Markets Study.

Sacramento Health Care Market: Key Takeaways

The Sacramento area is growing faster than California overall, and its four dominant health systems are building to match. New hospitals and clinics cluster in affluent suburbs where commercially insured residents are moving. Meanwhile Medi-Cal now covers more than one in three residents. Placer and El Dorado Counties launched new Medi-Cal managed care models, moving 50,000 enrollees through a bumpy transition. Specialty access remains the region’s sharpest problem, with Medi-Cal managed care plans falling far below state appointment wait time standards. Community health centers are expanding while absorbing rising costs and delayed payments. Federal and state cutbacks now threaten the coverage gains of recent years.

Six Key Developments Shaping Health Care in Sacramento

1. One of California’s fastest-growing regions, with health systems building to match. 

The four-county Sacramento area grew 4.2% since 2019 while the state shrank slightly, reaching more than 2.5 million people. Dignity Health, Kaiser Permanente, Sutter Health, and UC Davis Health are all adding hospitals, clinics, and medical office buildings, concentrated in the fast-growing suburbs of Elk Grove, Folsom, Roseville, and El Dorado Hills where younger, higher-income, commercially insured residents are moving. Seismic safety deadlines are driving part of the boom, including Kaiser’s $1 billion Railyards campus and UC Davis Health’s $3.7 billion hospital tower.

2. Medi-Cal now covers more than one in three residents, and those gains are at risk.

Coverage grew 6.7 percentage points between 2019 and 2023 to reach 35.6% of the region. Federal HR 1 could push as many as 3.4 million Californians off Medi-Cal. Expired enhanced premium subsidies have already made Covered California less affordable for roughly 100,000 local enrollees. The state froze new full-scope Medi-Cal enrollment for undocumented adults in January 2026.

3. Two counties launched new Medi-Cal managed care models, and the transition was rough. 

Placer moved to a County-Organized Health System and El Dorado to a Two-Plan model in 2024, shifting about 50,000 enrollees to new plans and sometimes new providers. Commercial plans exited, public plans entered, and network building was described as a “jumble,” especially for specialty physicians. Access has since improved. In Sacramento County, four plans still operate under Geographic Managed Care, and providers report continued friction across differing prior authorization, billing, and referral systems.

4. Specialty access is the region’s sharpest problem, and Medi-Cal patients feel it most.

Sacramento has more physicians per capita than the state, including specialists and psychiatrists. That supply does not translate into appointments. In 2024, three of four Sacramento County Medi-Cal plans fell well below statewide averages on appointment wait time standards, with urgent pediatric specialty compliance as low as 6.5%. All four plans received time or distance exceptions across 19 adult and 18 pediatric specialties. Independent practice keeps shrinking, and health system medical groups limit Medi-Cal participation.

5. Community health centers are expanding while running thin financially.

CHCs delivered more than 1.2 million encounters across 35 sites in 2023, adding locations, mobile units, and behavioral health capacity. They still serve fewer patients per capita than CHCs statewide. WellSpace Health closed three sites and laid off 135 employees in July 2024, citing higher labor costs, delayed CalAIM payments, and federal funding cuts. WellSpace also built a workaround for specialty access, partnering with UC Davis Health on Specialty Connect to pay specialists a flat fee to see Medi-Cal patients at clinic sites.

6. Behavioral health capacity is growing, though unevenly and with real implementation strain.

State infrastructure grants have funded or will fund more than 400 inpatient beds and 650 outpatient slots across the region, with over $170 million awarded in May 2025 alone. This expansion has included residential psychiatric treatment facilities, mental health rehabilitation centers, and peer respite centers. El Dorado County still has no inpatient psychiatric beds and sends patients as far as Southern California. Providers welcomed CalAIM’s Enhanced Care Management and Community Supports while describing rollout as “flying the plane while building it,” with regional enrollment in both programs trailing statewide rates.

Key Data on Sacramento

Health Insurance Coverage

Where do Sacramento residents get their health coverage?

Sources: “MA State/County Penetration (July 2023),” US Centers for Medicare & Medicaid Services “Selected Characteristics of Health Insurance Coverage in the United States, American Community Survey, 1-Year and 5 Year Estimates,” US Census Bureau “By Medicare Dual Status, Certified Eligibles,” California Department of Health Care Services Katherine Wilson, “California Health Insurers, Enrollment Almanac — 2025 Edition,” California Health Care Foundation

Population and Economic Context

How does Sacramento compare to California overall?

Sources: “Annual Estimates of the Resident Population for Counties in the United States: April 1, 2020 to July 1, 2024 (CO-EST2024-POP),” US Census Bureau “Annual Estimates of the Resident Population for Counties in the United States: April 1, 2010 to July 1, 2019 (CO-EST2019-ANNRES-06),” US Census Bureau “American Community Survey 5-Year Estimates Subject Tables, S1901, Income in the Past 12 Months (in 2023 Inflation-Adjusted Dollars), 2023,” US Census Bureau “Current Industry Employment and Unemployment Rates for Counties,” California Employment Development Department “Housing Affordability Index – Traditional (Q2 2024),” California Association of Realtors “Healthcare Payments Data Measures Data (2018–2023),” California Department of Health Care Access and Information “Infant Mortality,” California Department of Public Health “California Overdose Surveillance Dashboard,” CDPH, last updated May 19, 2025 “American Community Survey, 2023 5-Year Estimates, S1810, Disability Characteristics,” US Census Bureau

Hospital Landscape

What are the largest hospital systems serving Sacramento?

Source: “2023 Pivot Table – Hospital Annual Selected File,” California Department of Health Care Access and Information

Community Health Centers

What are the largest community health center (CHC) systems in Sacramento?

Source: “2023 Primary Care Clinic Annual Utilization Data (November 2024),” California Department of Health Care Access and Information, last updated October 31, 2024

Health Care Workforce

How does Sacramento compare to California?

Source: “2024 License Renewal Survey Data, Representing Active Licenses as of December 3, 2024,” custom data request, HCAI, received April 14, 2025.

Authors and Contributors