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History of Medi-Cal Rates

Fighting to Fulfill the Medi-Cal Promise

because ALL Californians deserve
ACCESS to quality health care.

Medi-Cal provides essential health coverage to one in three Californians and is foundational to the state’s health care delivery system and economy. To fulfill California’s commitment to health care access and equity, we must ensure that the remarkable gains we’ve had expanding health care coverage actually translate to improved access to care for Californians.  

We know we can do better for Californians.

California is 47th in the nation for Medicaid reimbursement rates.

WAITING FOR HEALTH CARE

Although the Medi-Cal caseload has continued to grow, the funding for the program has been stagnant for decades. The result is that Medi-Cal providers have been asked to continue seeing their patients with rates that were last increased almost 25 years ago. Reimbursements have always lagged behind other programs such as Medicare and employer-based private health coverage, but the rising cost of inflation and growth in the program has become untenable for many practitioners. Patients on Medi-Cal are increasingly delaying care, waiting weeks or months for appointments, and traveling long distances to receive care. 

Unfunded Expansions

Over the course of the last decade, California policymakers have expanded eligibility to the Medi-Cal program:

  • 2014: The state opted into ACA Medi-Cal expansion
  • 2016: Coverage expanded to all income-eligible residents up to age 18
  • 2020: Coverage expanded to all residents 19-25 years old
  • 2022: Coverage expanded to all residents over 50 years old
  • 2024: Coverage will expand to all income-eligible residents, regardless of age or documentation status

 

We Want to Know Your Story

Share your unique experience as a Medi-Cal patient, physician or health care professional. Your story can help CMA explain why we must improve access for Medi-Cal beneficiaries in a sustainable manner. 

“Medi-Cal patients are unable to find the primary and specialty care they need, they are waiting months for appointments and traveling long distances just to get care. The Medi-Cal program is woefully underfunded which has truly devastating consequences on the health and well-being of my patients."

– Jerry P. Abraham, M.D., MPH, CMQ, community health center physician practicing in South Los Angeles

Medi-Cal rates have not increased in more than two decades.

2000

The last broad rate adjustment for physician rates in Medi-Cal. It represented a 15.6% rate increase.

2008

Physicians' Medi-Cal reimbursement rates were cut by 1% or 5% on specified codes/services (AB 1183).

2011

10% rate reduction in Medi-Cal fee-for-service and actuarial equivalent in Medi-Cal managed care.

2016

Supplemental rate increase for limited physician codes, as well as dental and family planning services (Prop 56).

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LOOKING AHEAD

Closing the gap that exists between Medicaid and other sources of insurance would fundamentally reduce access disparities for children and adults, and would:

  • Increase health care quality for all Californians
  • Reduce wait times for appointments
  • Benefit millions

With plans to add millions more enrollees to the Medi-Cal program in coming years, it remains more important than ever to ensure that health care dollars remain in our health care system.