How does Medi-Cal work and what would budget cuts mean? Here's what you should know

A budget proposal from House Republicans, if implemented, could mean cuts to Medicaid, according to analysts.

California's Medicaid program is called Medi-Cal, and it provides healthcare for more than one third of Californians, according to the California Budget & Policy Center.

With Medicaid and Medi-Cal in the news, LAist put together a Q&A about the program, how it's funded and who it serves.

Medi-Cal is Medicaid?

Yes. California just has a different name for it.

Nicole Jorwic with the advocacy organization Caring Across told LAist that some people get confused because of the different names, but that it's important Californians know that when they hear about Medicaid, for us that means Medi-Cal.

Who is covered by Medi-Cal?

Californians under a certain income level are eligible for Medi-Cal coverage — up to 138% of the federal policy level for adults and up to 213% for pregnant people.

Other people who can access Medi-Cal include people who are 65 and older, are blind or disabled, are in long-term care, or former foster care youth up to the age of 26.

How is Medi-Cal funded?

Medi-Cal receives funds from the state and the federal government. Nearly two-thirds of the state's Medi-Cal funding is federal.

How many kids in California are covered by Medi-Cal?

More than 40% of California children are covered by Medi-Cal, per the California Health Care Foundation.

What is the Children's Health Insurance Program (CHIP)?

CHIP allows some families above Medicaid income thresholds to access low-cost health insurance for children.

How has Medi-Cal changed over the years?

The number of people enrolled in Medi-Cal has quadrupled in size since 1990, according to the Public Policy Institute of California.

A huge bump in those numbers came following the Affordable Care Act, which allowed adults without disabilities or kids to access Medicaid. As of 2024, one-third of Medi-Cal members became eligible under the ACA, per the Public Policy Institute's report.

Medi-Cal has continued expanding. In 2024, all undocumented people who meet income limits became eligible.

That growth has not been without its challenges. California is currently $6.2 billion over projected Medi-Cal spending, according to recent reporting from CalMatters.

How have challenges to Medicaid looked in the past?

In 2017, House Republicans passed a bill that would have walked back parts of the Affordable Care Act, and shrunk Medicaid eligibility. It didn't make it through the Senate.

How could cuts or changes to Medicaid look this time around?

The House budget bill does not include details on how proposed cuts might be achieved.

Adriana Ramos-Yamamoto, a policy analyst with the California Budget & Policy Center, said one approach could include enacting a work requirement for Medicaid, which could lead to many people losing coverage due to ineligibility or inability to navigate the bureaucracy.

Our partners at KFF Health News also took a detailed look at how cuts to Medicaid could look in California.

Would cuts to Medicaid impact other services?

Special Supplemental Nutrition Program for Women, Infants, and Children, which gives pregnant people and young mothers under a certain income level free nutritional food and breast-feeding support, could be affected by changes to Medicaid. According to the National WIC Association, that's because of "adjunct eligibility" — which allows families to prove that they're eligible for WIC benefits by showing they already receive other services like Medicaid.

" We know that streamlining the application process for each of these programs, removing administrative burdens, makes it more likely that families will choose to participate, and makes it easier for them to do so," said Nell Menefee-Libey with the National WIC Association. "So any proposals that could result in families losing access to Medicaid or to SNAP would also make it harder for them to access WIC."