Publications / 2019 Edition — California’s County-Based Health Plans

2019 Edition — California’s County-Based Health Plans


California’s county-based health plans are public entities organized through one or more counties to ensure that Medi-Cal enrollees, and in some cases county employees and Covered California enrollees, receive comprehensive care. Most county-based health plans are independent public agencies organized under California law as either “local initiatives” or County Organized Health Systems.

Learn about these plans: who they are, where they operate, and how their enrollment and finances have changed between 2012 and 2018.

∗Data are shown for the 16 county-based health plans regulated by the Department of Managed Health Care. Data are not available for Gold Coast Health Plan, which is operated by Ventura County and licensed solely by the Department of Health Care Services.

A Time of Change: 2012 to 2018

All County-Based Plans Combined

Enrollment growth stopped by the end of 2018.

Revenue nearly tripled between 2012 and 2015. Revenues grew more slowly in 2016 and 2017, and declined slightly in 2018.

Net income rose through 2015, but then fell, resulting in an overall margin of 0.4% in 2018.

Health Plan Details

Two policy changes fueled rapid enrollment growth in county-based plans through 2015. First, California expanded Medi-Cal managed care to all counties in 2013. Second, the Affordable Care Act created new categories of Medicaid eligibility.

Revenue in the 2012 to 2018 period expanded even faster than enrollment, with growth concentrated in the 2012 to 2015 period. In 2018, six plans experienced revenue declines.

Margins rose for most plans during the 2013 to 2015 expansion period and declined as revenues flattened in subsequent years. By 2018, margins had eroded to the point that four plans lost money.

Where County-Based Plans Operate

Scroll over a county to find out which plan is available. Counties mapped in grey do not have county-based health plans.


The data file and individual charts are available for download below. These materials are part of CHCF’s California Health Care Almanac, an online clearinghouse for key data and analyses describing the state’s health care landscape. See our entire collection of current and past editions of California Health Insurers and Enrollment.

Notes: Enrollment figures are as of June. Revenue, net income, and margin reflect fiscal year annual results. All growth is annual, except 2012 to 2018 growth, which is the change in 2018 over 2012 figures. Contra Costa Health Plan and Valley Health Plan include both Medi-Cal enrollees and county employees; Ventura County Health Care Plan was established to serve county employees and their dependents.

Source: “Health Plan Financial Summary Reports” (2012–18), Dept. of Managed Health Care.

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