Medi-Cal Eligibility and Enrollment: Current Status and Challenges

Health Management Associates


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 also pays for more than 50% of all births in the state and 58% of all patient days in long-term care facilities. In total, 13 million, or one in three, Californians rely on the program for health coverage. Medi-Cal pays for essential primary, specialty, acute, behavioral health, and long-term care services.

This fact sheet provides a high-level overview of the eligibility determination and enrollment process for the Medi-Cal program, including:

  • Which populations are eligible under the Medicaid eligibility groups
  • How eligibility is determined based on individual and household circumstances
  • How beneficiaries are enrolled in Medi-Cal managed care plans
  • Ways in which Medi-Cal has streamlined the enrollment process (“No Wrong Door”) and expanded coverage

This fact sheet is part of the Medi-Cal Explained series.