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Medi-Cal Adult Full Scope Expansion Programs
This dataset contains data pertaining to the full scope expansion of the Adult Medi-Cal population, regardless of immigration status, within three (3) different age groups, each of the age groups is a result of different California legislation. The different age groups are identified below as well as the Senate or Assembly Bill citation for each. __Note:__ Counties with zero individuals enrolled during a reporting period are not included in the dataset. * __Age 19-25 Young Adult Expansion Population:__ The datasets include the monthly count of individuals ages 19 through 25, by county, receiving full scope Medi-Cal benefits. The counts reflect the total number of eligible individuals enrolled during the month. California provides full scope Medi-Cal benefits to young adults ages 19 through 25, regardless of immigration status. Lawfully present individuals ages 21 through 25, who are not in a pregnancy aid code, are included in this count. Individuals in the dataset are eligible for federal financial participation for their emergency and pregnancy-related services. The Young Adult Expansion program was implemented January 1, 2020, pursuant to [Senate Bill 104 (Chapter 67, Statutes of 2019)](https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB104), [California Welfare and Institutions Code Section 14007.8.](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=14007.8.) * __Age 26-49 Adult Expansion Population:__ The datasets include the monthly count of individuals 26-49 years of age, by county, receiving full scope Medi-Cal benefits. The counts reflect the total number of eligible individuals enrolled during the month. California provides full scope Medi-Cal benefits to adults 26-49 years of age, regardless of immigration status. Lawfully present individuals 26-49 years of age, who are not in a pregnancy aid code, are included in this count. Individuals in the dataset are eligible for federal financial participation for their emergency and pregnancy-related services. The Age 26-49 Adult Expansion program was implemented January 1, 2024, pursuant to [Senate Bill (SB) 184 (Chapter 47, Statutes of 2022)](https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB184), [California Welfare and Institutions Code Section 14007.8.](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=14007.8.) * __Age 50 and over Older Adult Expansion Population:__ The datasets include the monthly count of individuals 50 years of age or older, by county, receiving full scope Medi-Cal benefits. The counts reflect the total number of eligible individuals enrolled during the month. California provides full scope Medi-Cal benefits to adults 50 years of age or older, regardless of immigration status. Lawfully present individuals 50 years of age or older, who are not in a pregnancy aid code, are included in this count. Individuals in the dataset are eligible for federal financial participation for their emergency and pregnancy-related services. The Older Adult Expansion program was implemented May 1, 2022, pursuant to [Assembly Bill (AB) 133 (Chapter 143, Statutes of 2021)](https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB133), [California Welfare and Institutions Code Section 14007.8.](https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=14007.8.)
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SB 75 - Full Scope Medi-Cal for All Children Enrollment
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This dataset includes the monthly count of individuals under age 19 receiving full scope Medi-Cal benefits as authorized by California Welfare and Institutions Code 14007.8. The count reflects the total number eligible during the month. California provides full scope Medi-Cal benefits to all children under the age of 19 regardless of immigration status. This program is referred to as SB 75 and was implemented May 16, 2016 pursuant to SB 75 (Chapter 18, Statutes of 2015), Section 14007.8 and added to the Welfare and Institutions Code and amended by SB 4 (Chapter 709, Statutes of 2015).
Number of Individuals Transitioned from Covered California Qualified Health Plans to Medi-Cal
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This dataset includes the number of individuals transitioned from Covered California Qualified Health Plan (QHP) eligibility to Medi-Cal enrollment commencing with the 2016 Quarter 4 Report. The individuals in this dataset represent Covered California clients, regardless of QHP enrollment status, who are in a Carry Forward Status (CFS) after reporting a change making them potentially eligible for MAGI Medi-Cal during a reporting period. The total number of individuals transitioned from Covered California includes Medi-Cal eligible individuals who did not have Medi-Cal eligibility in the month prior to the reporting period. This is a new dataset as a result of implementing the Covered California QHP Carry Forward Status indicator in release 16.9 and is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.
Medi-Cal Annual Renewals by County
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This dataset includes information regarding annual Medi-Cal eligibility renewals conducted for beneficiaries by counties each month. The data is from the Statewide Automated Welfare System (SAWS), which determines Medi-Cal eligibility and conducts ongoing case management. The SAWS reports the number of renewals due and the renewals completed by the due date and within the renewals processing timeframe. This dataset is part of the public reporting requirements set forth in California Welfare and Institutions Code 14102.5(3) et seq.
Medi-Cal Enrollment by Eligibility Group
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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).
Medi-Cal Enrollment by Eligibility Group
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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).
Newly Eligible Individuals enrolled in Medi-Cal Managed Care Health Plans
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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.
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