About This Series
In late 2025, the California Health Care Foundation (CHCF) issued a Call for Bold Ideas to Strengthen and Preserve Medi-Cal, inviting leaders from across health care, policy, research, and community organizations to propose transformative ideas for the program’s future. Rather than incremental improvements, applicants were asked to imagine how Medi-Cal could evolve over the next decade to better serve Californians.
The response was incredible: CHCF received 132 proposals from researchers, clinicians, policy experts, community leaders, and others across California. The submissions reflected a wide range of perspectives and revealed strong interest in rethinking payment models, strengthening care coordination, leveraging new technology, and addressing the needs of people with complex health and social challenges.
From these submissions, CHCF selected six concepts for further development. Each author team received support to expand its proposal into a full paper exploring the policy rationale, implementation considerations, and potential trade-offs of the idea.
Together, these papers offer a diverse set of perspectives on how Medi-Cal could evolve to meet the challenges of the next decade.
Why This Matters Now
Medi-Cal is the cornerstone of California’s health care system. The program covers roughly 15 million Californians and serves as a critical foundation for hospitals, clinics, and safety-net providers across the state.
But the environment surrounding Medi-Cal is changing. Rising costs, demographic shifts, and uncertainty about federal Medicaid funding are putting new pressure on the program and raising fundamental questions about how it should evolve in the years ahead.
These papers are intended to spark discussion, challenge assumptions, and broaden the range of policy options under consideration as California looks toward the future of Medi-Cal.
The Proposals
The following papers present six proposals for how Medi-Cal could evolve to better serve Californians in the years ahead. (Note: The views expressed are those of the authors and do not necessarily reflect the views of CHCF.)
Any Card, Any Provider: Unifying Medi-Cal’s Networks and Administration
Naman Shah, MD, PhD, Los Angeles County Department of Public Health
Shah proposes separating administrative functions — such as claims processing and provider credentialing — from health plans so that Medi-Cal members can see any credentialed provider. The model would allow plans to compete on care quality and outcomes rather than network restrictions.
Consideration of a Medicaid Per Capita Cap
Beth Waldman and Mary Beth Dyer, Bailit Health
Waldman and Dyer explore a shift from open-ended federal matching funds to a per capita cap model for Medicaid, examining how this approach could offer California greater policy flexibility and budget predictability as federal financing evolves.
In-Home Supportive Services Integration into Medi-Cal Managed Care
Chapman Consulting
Chapman and Nye propose integrating In-Home Supportive Services (IHSS) into Medi-Cal managed care to improve care coordination and oversight while preserving recipient self-direction. The model aims to better align long-term services and supports with members’ broader health needs.
Multipayer Primary Care Payment Reform Model
Rachel Tobey, MPA
Tobey outlines a unified primary care payment model across Medi-Cal, CalPERS, and Covered California. The approach would align incentives, reduce administrative complexity, and support sustainable, team-based primary care.
Partially Unified Financing: Covered California for Most
Rick Kronick, PhD, University of California, San Diego
Kronick proposes transitioning most Californians — including many currently enrolled in Medi-Cal — into Covered California plans. The model aims to create a more continuous and equitable coverage system while reducing fragmentation across programs.
AI-Powered Advocates for Medi-Cal
Nate Favini, MD; Neil Batlivala; Pair Team
Timi Leslie; Stephanie Thornton; Madison Olmsted, BluePath Health
Favini and Batlivala propose creating an AI “app store” for Medi-Cal — one where members choose to work with AI Advocates that proactively respond to rising risk levels and initiate outreach, navigation, and enrollment.
