Accountability in the Medi-Cal Managed Care Program

Medi-Cal Explained: Fact Sheet

Medi-Cal Explained

This publication is part of CHCF’s Medi-Cal Explained series. The series provides an overview of the program, including the people it serves, the services it provides, and how it is organized, managed, and financed.

Medi-Cal, California’s Medicaid program, is the state’s health insurance program for Californians with low incomes, including 40% of all children, half of all people with disabilities, over a million seniors, and nearly four million adults. It is administered by the state’s Department of Health Care Services (DHCS). Approximately 82% of Medi-Cal beneficiaries are enrolled in a Medi-Cal Managed Care Plan (MCP), a private or public health insurance entity that takes responsibility for most of an enrollee’s medical benefits, including primary care, specialty care, and non-specialty mental health services. There are more than 30 full-service and specialty MCPs that participate in Medi-Cal’s managed care program.

This fact sheet provides a high-level overview of how DHCS assesses and addresses quality in the Medi-Cal Managed Care Program, including:

  • What data DHCS uses to assess quality
  • What MCP quality information is publicly available
  • How DHCS addresses poor quality