How to Choose a Medi-Cal (Medicaid) Managed Care Plan in California

Nearly 14 million Californians (13,910,180 as of April 2026) are covered by Medi-Cal,1 and roughly 90 percent of them get their care through a managed care plan, not fee-for-service.2 Most never learn how the system works, or why their county offers only certain plans. Medi-Cal (California Medicaid) overhauled its managed care market on January 1, 2024, and that decides the care you can actually reach.

Why Medi-Cal (California Medicaid) Uses Managed Care

Medi-Cal, California's Medicaid program, delivers most of its care through plans rather than fee-for-service, and the reason matters to you as a member: the plan contract is where the state puts the programs you can actually use.

California's Section 1115 demonstration, California Advancing and Innovating Medi-Cal (CalAIM), is authorized through December 31, 2026, with a renewal application pending for 2027 through 2031. It operationalizes Enhanced Care Management and Community Supports through the contracts the Department of Health Care Services (DHCS) holds with managed care plans.4 That is why your plan, rather than the state directly, is the front door to those benefits.

The federal authorities underlying the system are layered: the Title XIX state plan for the core entitlement, the Section 1115 CalAIM demonstration, and a Section 1915(b) waiver for the managed care delivery system, both authorized through December 31, 2026.1

The Five County Delivery Models

Effective January 1, 2024, DHCS reorganized the managed care market into five operating models. The fifth, Single-Plan, is a county where DHCS contracts with one plan that operates under the authorization and sponsorship of a county or local authority.2

A separate Kaiser Permanente direct contract overlays 32 counties as a parallel pathway for eligible members, but Kaiser is not a county model; it is a separate eligibility track described later in this guide.2

County Organized Health Systems, All Six Plans

COHS plans are run by county government entities under Welfare & Institutions Code section 14087.5 et seq. A county's board of supervisors may establish, by ordinance, a commission that negotiates the COHS contract with DHCS and oversees it. Each COHS is the sole Medi-Cal plan operating in its county, with no commercial competitor.2

• Partnership HealthPlan of California covers much of rural Northern California and absorbed several former Regional Model counties when the 2024 procurement took effect.
• CalOptima Health serves Orange County.
• CenCal Health serves Santa Barbara and San Luis Obispo counties.
• Central California Alliance for Health (the Alliance) serves Mariposa, Merced, Monterey, San Benito, and Santa Cruz, and launched its Medi-Medi Plan across those counties in 2026.
• Gold Coast Health Plan serves Ventura County and is closely integrated with Ventura County Medical Center.
• Health Plan of San Mateo serves San Mateo County. If you also use In-Home Supportive Services, ask your plan how the two fit together.

Single-Plan Counties

Three counties operate as Single-Plan counties, where one county-sponsored plan is the Medi-Cal plan: Alameda (Alameda Alliance for Health), Contra Costa (Contra Costa Health Plan), and Imperial (Community Health Plan of Imperial Valley). Kaiser Permanente's direct contract overlays all three for members who qualify for it.

The biggest change was in Imperial County, where members moved to Community Health Plan of Imperial Valley.

Two-Plan Counties, County by County

The Two-Plan model preserves member choice between a Local Initiative and a single commercial plan. The active Two-Plan pairings as of 2026, per DHCS, are:2

A note on Los Angeles. DHCS lists LA as a Two-Plan county, and its 2026 Medi-Cal plans are L.A. Care Health Plan and Health Net Community Solutions, with Kaiser direct available to members who qualify. Several other insurer names do appear in LA, but as Medi-Medi Plans for dual eligibles rather than as Medi-Cal plans you can choose (see the Medi-Medi section below). That distinction is worth keeping straight before you call to switch.2

Geographic Managed Care (GMC), Sacramento and San Diego

GMC counties are the only ones where multiple commercial plans compete with no Local Initiative. Both took effect January 1, 2024.2

• Sacramento: Anthem Blue Cross, Health Net, Kaiser direct, and Molina.
• San Diego: Blue Shield Promise, Community Health Group, Kaiser direct, and Molina.

The Regional Model, Smaller Now Than Before

The Regional Model was historically used for the lowest-population counties. It shrank sharply in 2024 because Partnership HealthPlan absorbed many former Regional counties. The remaining Regional counties are Amador, Calaveras, Inyo, Mono, and Tuolumne, all "Anthem and Health Net" pairs.2

The 2024 Statewide Procurement

California's 2024 statewide procurement reset the commercial Medi-Cal contracts, and the new contracts took effect January 1, 2024. It is why the plan list in your county may look different from what a neighbor remembers.2

The Five Commercial Winners

1. Anthem Blue Cross Partnership Plan (contract name Blue Cross of California Partnership Plan), serving counties including Fresno, Kern, Sacramento, San Francisco, and Santa Clara.
2. Health Net Community Solutions, serving counties including Los Angeles, Sacramento, San Joaquin, and Stanislaus.
3. Molina Healthcare of California, serving Riverside, San Bernardino, Sacramento, and San Diego.
4. Blue Shield of California Promise Health Plan, serving San Diego County.
5. Community Health Group Partnership Plan, serving San Diego County.2

If a plan you used to have no longer appears in your county's list, that is usually the 2024 reset rather than anything to do with your own eligibility.

The Kaiser Permanente Direct Contract, SB 510 and AB 2724

Kaiser Permanente operates under an arrangement no other commercial Medi-Cal plan has: a direct statewide contract with DHCS, authorized by Senate Bill 510 (2021) and Assembly Bill 2724 (2022). The contract took effect January 1, 2024.2

Service Area, 32 Counties

Kaiser's direct Medi-Cal contract covers 32 counties, including Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, Santa Clara, and Ventura. This expanded Kaiser's Medi-Cal footprint into counties where it previously had only a commercial line.2

Who Can Enroll With Kaiser

This is the part that surprises people. Kaiser's direct contract holds it to the same 2024 contract standards as every other Medi-Cal plan except the standards governing member enrollment, so who may join Kaiser is decided by a different set of rules.2 Living in one of the 32 counties is not by itself enough to guarantee you can pick Kaiser.

So before you count on Kaiser, call Health Care Options at 1-800-430-4263 and ask whether you qualify to enroll with Kaiser in your county.5 Ask before you fill in a Choice Form, because Kaiser's care is delivered through its own clinicians and hospitals rather than a contracted outside network.

Beyond the six COHS plans, the Two-Plan counties are anchored by a Local Initiative, a county-authorized plan that DHCS contracts with alongside one commercial plan (L.A. Care, Inland Empire Health Plan, CalViva Health, Kern Family Health Care, Santa Clara Family Health Plan, San Francisco Health Plan, and the rest listed in the table above).2

Plan Ratings and Quality

If you have a real choice of plan, quality ratings are one input worth ten minutes. California's Office of the Patient Advocate (OPA) publishes a Health Plan Quality Report Card at reportcard.opa.ca.gov, and the National Committee for Quality Assurance (NCQA) publishes Medicaid health plan ratings.

Ratings move year to year, so look up the current rating for the specific plans offered in your county rather than relying on a plan's general reputation. And weigh a rating against the thing that usually matters more day to day: whether your own doctors and hospital are in the plan's network.

Medi-Medi Plans, The Big 2026 Change

If you are dually eligible for Medicare and Medi-Cal, the most important change on January 1, 2026 was the expansion of Medi-Medi Plans, California's brand for Exclusively Aligned Enrollment Dual-Eligible Special Needs Plans (EAE D-SNPs), from 12 counties to 41 counties, adding 29 counties.2

A Medi-Medi Plan is a Medicare Advantage D-SNP whose membership is limited to dual eligibles who are also enrolled in the affiliated Medi-Cal plan, and it delivers care coordination and integrated member materials across both programs. To join, you need Medicare Part A and Part B plus Medi-Cal, and you must be 21 or older.6 Before this alignment, dual eligibles in California typically had to navigate two separate plans for two separate programs.

The Matching Plan Policy

The mechanism behind the alignment is DHCS' Matching Plan Policy: your Medicare plan choice leads and your Medi-Cal plan follows it. The policy applied in 17 counties in 2025 and is being implemented in all counties in 2026.6

Los Angeles 2026 Medi-Medi Plans

Los Angeles County has extra Medi-Medi Plans because of plan delegation. DHCS's published 2026 landscape lists the LA Medi-Medi Plans as Anthem, Blue Shield, Kaiser Permanente, L.A. Care, Molina, SCAN Connections, and Wellcare.2 Note again that this is the Medi-Medi list, not the list of Medi-Cal plans an LA member can choose from.

What Your Plan Covers, and What It Does Not

A surprising amount of Medi-Cal sits outside the managed care plan's scope. The most important carve-outs to understand:

Pharmacy, Medi-Cal Rx (Statewide)

Effective January 1, 2022, all outpatient prescription drugs and pharmacy-billed medical supplies were carved out of Medi-Cal plan contracts and moved to a statewide fee-for-service program, Medi-Cal Rx, administered by Magellan Medicaid Administration.2 Physician-administered drugs billed on a medical claim (chemotherapy infusions, in-office injectables) stay in plan scope.

For members, the practical implication is simple: plan choice does not affect your pharmacy benefit, because that benefit is delivered statewide rather than by your plan. For help with pharmacy, call Medi-Cal Rx at 1-800-977-2273; agents are available 24 hours a day, 7 days a week.5

Behavioral Health, a Layered Carve-Out

California splits behavioral health responsibility across the plan and the county:

1. Specialty Mental Health Services, for adults with serious mental illness and youth with serious emotional disturbance, are delivered by each county's Mental Health Plan, not your managed care plan.2
2. Substance use disorder treatment runs through the Drug Medi-Cal Organized Delivery System in the many counties that operate it, and through traditional Drug Medi-Cal elsewhere.
3. Mild-to-moderate mental health and substance use care is administered by your managed care plan, including outpatient therapy, medication management, and screenings.

Dental, County-Specific

Most dental care is delivered through Medi-Cal Dental rather than through your managed care plan, so your plan choice generally does not decide your dentist.2 For questions about dental services or Medi-Cal Dental programs, including what applies in your county, call 1-800-322-6384.5

Vision, Transportation, and Care Management, In-Plan

Vision care and medical transportation are not on the carve-out list above, so they are generally arranged through your plan rather than statewide; ask your plan how it handles a ride to an appointment. Enhanced Care Management provides intensive care coordination for members with complex needs, organized around defined Populations of Focus, and Community Supports are 14 pre-approved services (such as housing navigation, recuperative care, and medically tailored meals) that plans may offer in lieu of standard services.4

Other 2026 Changes Members Should Know About

Asset limit reinstatement, and its 2027 expiration date. Under AB 116 (Chapter 21, Statutes of 2025), the non-MAGI Medi-Cal asset limit was reinstated effective January 1, 2026 at $130,000 for one person, plus $65,000 for each additional household member, up to 10 people. Those figures are temporary: DHCS publishes them as running through June 30, 2027 only, and states that starting July 1, 2027 the limit drops to $21,000 for one person, $31,000 for two people, plus $1,550 for each additional person. Any plan built on the $130,000 number needs that date in it.1 It affects Aged & Disabled, Medically Needy, Working Disabled, long-term care, and Medicare Savings Program members. (See our Medi-Cal asset limits guide for full detail.)

Enrollment freeze. As of January 1, 2026, some adults can no longer sign up for full-scope Medi-Cal because of their immigration status. Adults who already have full-scope Medi-Cal keep it regardless of immigration status, so long as they renew on time and still meet Medi-Cal's other rules. Children ages 0 through 18, pregnant people, and people under age 26 who were in foster care on their 18th birthday remain eligible for full-scope Medi-Cal regardless of immigration status.1

CalAIM renewal. The current CalAIM demonstration runs through December 31, 2026. DHCS submitted a renewal application to CMS on May 11, 2026 seeking a five-year renewal that would run the demonstration through December 31, 2031 and expand its reach from 2027 through 2031. The renewal is still pending at CMS.4

How to Choose a Plan

When DHCS approves your Medi-Cal application, Health Care Options mails you a Choice Form. Work through these steps:

Switching Plans

You are not stuck with the first plan you choose. Changing your Medi-Cal health plan is one of the rights DHCS lists for members, and you exercise it through Health Care Options (HCO), the statewide enrollment broker.3

How to Make the Change

Call HCO at 1-800-430-4263 (TTY 1-800-430-7077) or use the Health Care Options portal. You can also ask HCO to mail you an information packet first.3

The Federal Floor: For Cause Anytime, 90 Days, Then Yearly

Federal Medicaid rules do not require a state to allow unlimited plan changes, but they do set a floor. Under 42 CFR 438.56(c), if a state chooses to limit disenrollment, its managed care contracts must let a member request disenrollment for cause at any time; without cause during the 90 days following initial enrollment (or the 90 days following the state's notice of that enrollment, whichever is later); and without cause at least once every 12 months after that.3

Read that as your worst case, not as California's rule: DHCS and Health Care Options describe changing your plan as a member right and publish no lock-in window, so start by calling HCO and asking. If you are told a change has to wait, ask about a change for cause, which the federal floor keeps open at any time.3

Continuity of Care, Up to 12 Months

Continuity of care is narrower than most people assume: it covers the move from fee-for-service Medi-Cal into a managed care plan, not every plan-to-plan switch. If you are required to enroll in a plan, you may keep seeing your existing fee-for-service provider for up to 12 months, provided you have a current relationship with that provider, the plan has no quality-of-care issues with them, the provider will accept the plan's contracted rates or fee-for-service rates, and the provider is a California State Plan approved provider. To start it, contact your new plan and give them the provider's name.3

Bottom Line

If you are on Medi-Cal in California, your managed care plan is the front door to almost every benefit you have. The right plan is the one whose network includes your doctor, whose specialists you can actually reach, and whose ratings on the measures you care about are strong.

Statewide Reference Numbers

Learn More

Find personalized help choosing or switching a Medi-Cal managed care plan at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.