This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care County Organized Health System (COHS) Health Plans by reporting period. COHS is a Medi-Cal managed care health plan model that operates in 22 California counties. Each COHS is created by a county board of supervisors and governed by an independent commission. In COHS counties, a single plan serves all Medi-Cal beneficiaries enrolled in managed care. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.

This dataset identifies California’s eligibility groups by aid code. California uses aid codes to account for eligibility group populations and the eligibility requirements, scope of benefits, services, costs, claims, encounter data, and managed care arrangements related to those populations. Aid codes in this dataset are mapped to the Transformed Medicaid Statistical Information System (T-MSIS) eligibility group descriptions and codes. California uses this mapping to submit claims data, enrollee encounter data, and supporting information to the Centers for Medicare & Medicaid Services (CMS), as required by Section 4735 of the Balanced Budget Act of 1997 and Section 6504 of the Affordable Care Act for the purpose of program integrity, program oversight, and administration. This dataset includes aid codes that do not have Medi-Cal benefits or have benefits and are not federal programs. Some aid codes may appear to be identical but possess distinct benefits or grouping factors. An aid code may appear more than once if multiple populations are represented in one aid code and can be identified and mapped to distinct T-MSIS groups.

The dataset presents the languages in each county that meet the threshold of 3,000 Medi-Cal beneficiaries or five percent (5%) of each county’s total Medi-Cal beneficiary population, whichever is lower. The data are quarterly (January, April, July, October) for January 2015 through most recent Quarter.

These files contain monthly data by county for Medi-Cal certified eligibles, by various demographics traits. The data is split out and not distributed as a single dataset for the purposes of de-identification.

Dataset contains counts of individuals certified eligible for Medi-Cal, by Month of Eligibility, Zip Code, and Sex, from Calendar Year 2005 to the most recent reportable month. Due to the amount of data presented, below the dataset has been split into three files. All datasets are derived from the most recent reportable months information.

This dataset includes the total number of individuals enrolled in Medi-Cal by eligibility group: Modified Adjusted Gross Income (MAGI), non-MAGI, and Children’s Health Insurance Program (CHIP). The groups are defined by the Centers for Medicare and Medicaid Services (CMS) Performance Indicators (CMSPI) reporting requirements. The Department of Health Care Services (DHCS) submits eligibility and enrollment data regarding Medicaid and CHIP monthly to CMS. The enrollment data represents enrollment totals as of 60 days after the eligibility month (indicated as “Reporting Period” in the dataset). CMS publishes the state total enrollments on the CMSPI website. The total enrollment comprises of individuals who are eligible for full scope Medi-Cal by MAGI – Child, MAGI – Adult, Non-MAGI Child, Non-MAGI Adult, and CHIP eligibility groups. DHCS does not report to CMS the total enrollment in limited scope Medi-Cal or state-only funded programs (indicated as the “Non-CMSPI” in the dataset).

This dataset includes the total number of individuals enrolled in Medi-Cal by eligibility group: Modified Adjusted Gross Income (MAGI), non-MAGI, and Children’s Health Insurance Program (CHIP). The groups are defined by the Centers for Medicare and Medicaid Services (CMS) Performance Indicators (CMSPI) reporting requirements. The Department of Health Care Services (DHCS) submits eligibility and enrollment data regarding Medicaid and CHIP monthly to CMS. The enrollment data represents enrollment totals as of 60 days after the eligibility month (indicated as “Reporting Period” in the dataset). CMS publishes the state total enrollments on the CMSPI website. The total enrollment comprises of individuals who are eligible for full scope Medi-Cal by MAGI – Child, MAGI – Adult, Non-MAGI Child, Non-MAGI Adult, and CHIP eligibility groups. DHCS does not report to CMS the total enrollment in limited scope Medi-Cal or state-only funded programs (indicated as the “Non-CMSPI” in the dataset).

This dataset provides the total number of Insurance Affordability Programs (IAPs) applications submitted with the help of an assister. This data is from the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS). IAPs are comprised of Medi-Cal and subsidized Qualified Health Plans (QHPs) offered through Covered California. Assisters are affiliated with Covered California and may include agents, Service Center Representatives, Certified Enrollment Counselors, County Eligibility Workers, and Plan-Based Enrollers. This dataset is part of public reporting requirements set forth in the California Welfare and Institutions Code 14102.5(5).

This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care Health Plans by type of enrollment by reporting period. Medi-Cal Managed Care program contracts for health care services through established networks of organized systems of care emphasizing primary and preventive care. Newly eligible Medi-Cal beneficiaries must choose a Managed Care health plan within 30 days of Medi-Cal enrollment, or they will be enrolled in a Managed Care health plan by default. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.