Medi-Cal (California’s Medicaid program) is the largest payer for health care services in the State, covering one-third, or 14 million, of the State’s residents. Of that number, nearly 80% (10.6 million) of Medi-Cal beneficiaries receive their care through a managed care delivery system. The California Department of Health Care Services (DHCS) is California’s Medicaid Agency.
Under fee-for-service Medi-Cal, beneficiaries are responsible for finding primary care providers and specialists who are willing to accept Medi-Cal; beneficiaries are not matched with a primary care provider who coordinates their care. The California Department of Health Care Services (DHCS) establishes fee schedules, negotiates rates with hospitals, determines medical necessity criteria and pays provider claims for services provided.