View the Report
Jump to All Downloads & LinksCalifornia’s county-based health plans are public entities organized through one or more counties to provide managed care to Medi-Cal enrollees, some Covered California enrollees, and some county employees. Most county-based health plans are independent public agencies organized under California law as either local initiatives or County Organized Health Systems. These plans cover one in every five Californians. Learn about these plans: what they are, where they operate, and how their enrollment and finances have changed in recent years.
2022 Highlights
All County-Based Plans Combined
Enrollment in county-based health plans (reported as of the end of June) was 9.8 million in 2023, a 10.4% increase over 2022. The growth between 2021 and 2023 was largely due to continuous coverage policies enacted during the COVID-19 public health emergency.
Revenue for county-based health plans totaled $37 billion in 2022. Revenue increased in both 2021 (12.6%) and 2022 (2.6%).
The overall margins for county-based health plans were 2.6% and 2.7% in 2021 and 2022, more than twice the margins between 2018 and 2020. Margin improvements were driven by medical expenses, which grew more slowly than revenues in 2021 and 2022. The total net income of all county-based plans in 2022 was $975 million, $42 million higher than 2021. In 2022, revenue increased by $924 million (2.6%), while medical expenses increased by $517 million (1.6%) and administrative expenses increased $272 million (16.4%).
The 1.6% increase in medical expenses in 2022 was much lower than the 9.1% increase in 2021.
Administrative expenses for all county-based health plans totaled $1.9 billion in 2022, a 16.4% increase over 2021.
Health Plan Details
The three county-based plans with the most enrollment operate in southern California counties. Partnership, the fourth largest, serves 14 northern counties. (See map below for health plans by county.) Enrollment in nearly all county-based plans increased in 2021, 2022, and 2023. In 2023, those that lost enrollees, L.A. Care JPA and Ventura County Health Plan, did not cover Medi-Cal enrollees.
Revenue increased for 12 of 16 plans in 2022. Average annual revenue growth from 2012 to 2022 ranged from 5% for Ventura County Health Plan to 20% for Inland Empire, Santa Clara Family Health Plan, and the Health Plan of San Joaquin.
Despite slower revenue growth in 2022 than 2021 for most plans, margins were similar to 2021. In 2022, 15 of 17 had positive margins. Margins ranged from -0.2% to 24.1%.
Where County-Based Plans Operate
Scroll over a county to see available plan(s). Gray counties do not have a county-based plan.
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. To see past editions of this almanac, contact us.
Notes: Enrollment as of June. Revenue, net income, and margin reflect fiscal year annual results. All growth is annual except revenue growth from 2012 to 2022, which is average annual. Contra Costa Health Plan and Valley Health Plan include both Medi-Cal enrollees and county employees; Ventura County Health Plan was established to serve county employees and their dependents. Data were not available for Gold Coast Health Plan, which is Ventura County’s Medi-Cal managed care plan. L.A. Care Joint Powers Agreement (JPA) converted its QIF license to a full Knox-Keene license effective 2022; its enrollment consists of In Home Supportive Services enrollees previously included in L.A. Care.
Source: “Health Plan Financial Summary Report” (2012–23), California Dept. of Managed Health Care.
Authors & Contributors
Katherine Wilson
Katherine Wilson is an independent consultant specializing in health insurance markets and health care costs. She is the author of numerous publications and reports, including CHCF’s series of reports on California health insurers.
