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

Roughly 90 percent of California's Medi-Cal members, more than 14 million people, get their care through a managed care plan, not fee-for-service.1 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.

This guide walks through California's Medi-Cal (Medicaid) managed care landscape: the five county delivery models, the 2024 statewide procurement, the Kaiser Permanente direct contract under SB 510 and AB 2724, the publicly organized Local Health Plans, the new Medi-Medi Plans that expanded to 41 counties on January 1, 2026, and the practical mechanics of choosing, or switching, your plan.1

Why Medi-Cal (California Medicaid) Uses Managed Care

Medi-Cal, California's Medicaid program, relies on managed care almost entirely by design. Three goals drive it:

1. Cost predictability. The Department of Health Care Services (DHCS) pays plans a per-member-per-month capitated rate, which protects the state General Fund from utilization spikes and shifts insurance risk to plans.
2. Care coordination at scale. A managed care plan is a single accountable entity for quality reporting, Enhanced Care Management, Community Supports, and the new Medi-Medi alignment.
3. CalAIM transformation lever. California's Section 1115 demonstration, the California Advancing and Innovating Medi-Cal (CalAIM) waiver, is authorized through December 31, 2026, with a renewal application pending for 2027 through 2031, and it operationalizes initiatives like Enhanced Care Management and Community Supports through the contracts DHCS holds with managed care plans. Fee-for-service Medi-Cal lacks those contractual touchpoints.3

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, 2026.4

The Five County Delivery Models

Effective January 1, 2024, DHCS reorganized the managed care market into five operating models. Older articles still reference a historical four-model taxonomy; the 2024 procurement created a fifth bucket called Single-Plan, where a Local Initiative serves as the sole plan in counties that previously had a Two-Plan structure.1

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.1

County Organized Health Systems, All Six Plans

COHS plans are public agencies established under Welfare & Institutions Code section 14087.5 et seq. by county boards of supervisors. They are nonprofit, governed by county-appointed boards, and have no commercial competitor in their counties.1

• 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 only and also runs integrated programs for older adults with complex needs.
• 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 and coordinates Medi-Cal with In-Home Supportive Services under one roof.

Single-Plan Counties

Three counties operate as Single-Plan counties, where the Local Initiative is the sole 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 Alameda and Contra Costa for eligible members.

The most consequential transition was in Imperial County, where the prior commercial contract ended and members moved to Community Health Plan of Imperial Valley, a new not-for-profit plan launched with the Imperial County Health Department.

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:1

A note on Los Angeles. DHCS still labels LA a Two-Plan county, but in practice LA members can pick from L.A. Care, Anthem, Blue Shield Promise, Health Net (with an embedded Molina subcontract), or Kaiser direct. L.A. Care is one of the largest publicly operated Medicaid health plans in the country.

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, 2024.1

• Sacramento: Anthem Blue Cross, Health Net, Kaiser direct, and Molina. (Aetna exited.)
• San Diego: Blue Shield Promise, Community Health Group, Kaiser direct, and Molina. (Aetna exited; Health Net lost San Diego in the 2024 procurement.)

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.1

The 2024 Statewide Procurement

The 2024 procurement was the largest reshaping of California Medi-Cal managed care in the program's history. It restructured commercial contracts, set new quality and equity requirements, and created a meaningfully different competitive landscape. The new contracts took effect January 1, 2024, and run for a multi-year term.1

The Five Commercial Winners

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

Who Lost Coverage

• Aetna Better Health of California exited the Medi-Cal market entirely on January 1, 2024 after losing both Sacramento and San Diego.1
• Health Net lost San Diego, where Blue Shield Promise, Community Health Group, Molina, and Kaiser now serve members.
• Health Net initially lost Los Angeles in the first award; a later settlement restored it via a Molina subcontract.

What DHCS Wanted From the Procurement

DHCS set four explicit goals in the contract:

1. Standardize quality, with a quality withhold tied to HEDIS performance and a National Committee for Quality Assurance (NCQA) accreditation requirement.
2. Improve health equity, with a mandatory health equity officer and stratified data collection.
3. Reduce administrative burden, through standardized credentialing and a common provider-directory format.
4. Strengthen oversight, with enhanced sanctions, public ratings, and mandatory corrective action plans.

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, 2024.1

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.1

Who Can Enroll With Kaiser

Kaiser's Medi-Cal eligibility is restricted, so not every Medi-Cal member can pick Kaiser. Eligible enrollees are generally:

1. Existing Kaiser members, who held Kaiser commercial or Medi-Cal coverage in the year before the contract began.
2. Family-linked members, household members of an existing Kaiser enrollee.
3. Foster youth and former foster youth in Kaiser's footprint, regardless of prior enrollment.
4. Dual eligibles, full-benefit Medicare and Medi-Cal members.
5. Continuity-of-care transferees, members who reached Kaiser through prior county subcontracts.
6. Whole Child Model and California Children's Services-eligible children in Kaiser's footprint.

Kaiser is also the default plan for newborns of enrolled members. Its closed, vertically integrated model (Kaiser-employed clinicians, Kaiser-owned hospitals) drives both its quality consistency and the eligibility restriction: Kaiser does not subcontract to outside networks.

Beyond the six COHS plans, California relies on a set of publicly organized, nonprofit Local Initiatives, the Local Health Plans that anchor the Two-Plan and Single-Plan counties (L.A. Care, Inland Empire Health Plan, CalViva Health, Kern Health Systems, Santa Clara Family Health Plan, and others). Together with the COHS plans they cover the large majority of Medi-Cal managed care members.1

Plan Ratings and Quality

DHCS publishes annual quality ratings, most visibly through the Office of the Patient Advocate (OPA) Health Plan Quality Report Card at reportcard.opa.ca.gov and the Medi-Cal Managed Care Performance Dashboard.1

Ratings are based on the Managed Care Accountability Set (MCAS), a fixed list of HEDIS, CAHPS, and DHCS-specific measures, benchmarked against national Medicaid performance levels. Plans that fall below the minimum performance level face monetary sanctions, mandatory corrective action plans, and public posting on the DHCS dashboard.

NCQA Medicaid plan ratings, released each fall on a star scale, are the other consumer-facing tool. Ratings vary year over year, so check the current NCQA Medicaid Health Plan Ratings page or the OPA Report Card for your county's plan before you decide. Kaiser Permanente's California Medicaid plans have historically rated near the top of the state.

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.1

A Medi-Medi Plan combines Medicare Advantage coverage with the matching Medi-Cal plan into a single integrated plan: one ID card, one provider directory, one care coordination team, and one set of customer-service numbers. Before this alignment, dual eligibles in California typically had to navigate two separate plans for two separate programs.

The Matching Plan Policy

The mechanism that drives alignment is DHCS' Matching Plan Policy. The rule: when a full-benefit dual eligible newly enrolls in a Medicare Advantage plan in an eligible county, their Medi-Cal plan aligns with the Medicare plan if the same parent company offers a matching Medi-Cal plan. Alignment now flows in both directions, from a new D-SNP enrollment to the matching Medi-Cal plan, and from a Medi-Cal member newly eligible for Medicare into the matching parent's D-SNP.

Los Angeles 2026 Medi-Medi Plans

Several Medi-Medi Plans are available in Los Angeles for plan year 2026, offered by Anthem, Blue Shield, Health Net (through its Wellcare line), Kaiser Permanente, L.A. Care, Molina, and SCAN. In counties with an aligned Medi-Medi Plan, Medicare D-SNPs that lack a matching Medi-Cal plan are closed to new dual-eligible enrollment, though existing members can stay enrolled.

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.1 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 network. Every Medi-Cal pharmacy in California accepts the same Medi-Cal Rx coverage, regardless of your plan. The Medi-Cal Rx Customer Service Center is 1-800-977-2273.5

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.1
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

In most counties, Medi-Cal Dental is delivered as fee-for-service, and you can see any participating Medi-Cal Dental provider. A few counties, including Sacramento and Los Angeles, use Dental Managed Care. Medi-Cal Dental member services is 1-800-322-6384.5

Vision, Transportation, and Care Management, In-Plan

Vision benefits (eye exams, glasses) are in your plan. Non-Emergency Medical Transportation and Non-Medical Transportation are also in your plan, usually through a transportation broker. 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.3

Other 2026 Changes Members Should Know About

Asset limit reinstatement. 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.4 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 for undocumented adults. Effective January 1, 2026, Medi-Cal froze new full-scope enrollment for undocumented adults age 19 and older; existing full-scope enrollees keep coverage as long as they complete their yearly Medi-Cal renewal.4

CalAIM renewal. DHCS is seeking CMS approval to renew CalAIM for 2027 through 2031, with expanded Enhanced Care Management, more Community Supports, and justice-involved pre-release coverage.3

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.2

The Initial 90-Day Open Switch

For your first 90 days after enrollment, you can switch plans for any reason, no cause needed. Switch online through the Health Care Options portal, by phone at 1-800-430-4263, or by mailing a Choice Form. The new plan typically takes effect the first of the month following your request.2

After 90 Days, Once Per Year, Plus Good Cause

Past the 90-day open window, you can switch once every 12 months without showing cause. You can also switch at any time, for cause, for reasons such as:2

• You move out of the plan's service area.
• You need related services (such as a transplant) from a network not in your current plan.
• Your primary care provider, specialist, or hospital leaves the plan's network.
• Documented quality-of-care concerns, established through a grievance.

Continuity of Care, Up to 12 Months

When you switch plans, your new plan must honor your existing provider relationships for up to 12 months, provided you have a current relationship with the provider, the plan has no quality-of-care concerns, the provider accepts the plan's rates, and the provider is a California State Plan-approved provider. Ask your new plan for continuity of care as soon as you switch.2

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.

Five things to remember:

1. You probably have more choice than you realize. Two-Plan, GMC, and Regional counties all let you pick. COHS and Single-Plan counties do not, but you still choose your providers within the plan.1
2. Health Care Options at 1-800-430-4263 is the single statewide tool for choosing, switching, and getting straight answers about your county's plan options.5
3. You can switch plans for any reason within 90 days of initial enrollment, and once a year after that, plus at any time for good cause.2
4. Continuity of care up to 12 months protects your existing provider relationships when you switch plans.2
5. Pharmacy, severe mental health, and most dental are carved out, so your plan choice does not affect those services.1

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.