What are the different Medi-Cal managed care plans and how do they differ?
California operates five main managed care models across its counties.
Approximately 15.2 million Californians are enrolled in Medi-Cal, California's Medicaid program, representing more than one-third of the state's population. Almost all of them must choose or be assigned to a managed care plan rather than using the traditional fee-for-service system. But Medi-Cal managed care plans come in different varieties, shaped by how counties have historically organized their health systems.
The differences affect whether an enrollee gets to choose their plan, which doctors and hospitals are available to them, and how care is coordinated. Understanding these distinctions matters because California beneficiaries shopping for coverage need to know what options exist in their county and how plans compare.
The five main managed care models
California operates five primary managed care structures across its 58 counties, each reflecting local healthcare traditions and the historical role counties have played in delivering public health services.
The Two-Plan Model, California's largest structure, operates in 14 counties and gives enrollees a choice between two plans: a commercial plan selected through state competition, and a "Local Initiative" plan run by the county or a local entity. This model emerged from California's emphasis on preserving safety-net providers and county public hospitals. About 64% of managed care enrollees use these Two-Plan counties.
County Organized Health Systems (COHS) serve 22 counties as single mandatory plans—meaning all Medi-Cal managed care enrollees in these counties enroll in one plan. These county-run systems have deep roots; some began in the 1980s when counties sought to control healthcare costs. About 21% of managed care enrollees are in COHS counties.
Geographic Managed Care (GMC) operates in only two counties—Sacramento and San Diego—and uses true competition, contracting with multiple commercial and nonprofit plans. Enrollees choose from among these competing options. About 11% of managed care enrollees live in GMC counties.
The Regional Expansion Model serves 18 rural counties and contracts with two commercial plans. This model was designed for areas with smaller, more dispersed populations, particularly when children covered by the state's Children's Health Insurance Program (CHIP) transitioned to Medi-Cal in 2013. A sixth, smaller model operates in San Benito County and uniquely allows enrollees to choose between staying in fee-for-service Medi-Cal or joining a commercial managed care plan.
Enrollment and network structure
The key practical difference between these models is choice. In Two-Plan and GMC counties, Medi-Cal members select a plan. In COHS and most Regional Model counties, enrollment is mandatory into the available plan or plans. The state assigns beneficiaries who do not actively choose a plan, using automated matching. The state assigns beneficiaries who do not actively choose a plan based on county and circumstances.
Each plan operates its own provider network. Doctors, hospitals, and clinics must contract with a specific managed care plan to serve that plan's enrollees; a provider might participate in one plan's network but not another's in the same county. This affects which providers are available to enrollees. Two-Plan counties, which emphasize preserving public providers, typically include county hospitals and safety-net clinics in the Local Initiative plan's network. Commercial plans in these counties may use different networks, and the differences can be substantial, particularly for specialists or rural providers.
Services and cost sharing
All Medi-Cal managed care plans must cover the same set of core services, including inpatient and outpatient hospital care, physician services, mental health services for mild to moderate illness, and emergency services. Importantly, Medi-Cal managed care plans cannot charge copayments, coinsurance, or deductibles—all covered services are free to enrollees.
Some services remain outside managed care plans and are paid through the traditional fee-for-service system. These include certain long-term services and supports, specialized mental health services, substance use disorder treatment, dental care, and most pharmacy services. This split means that an enrollee may have some care coordinated through their managed care plan and some covered separately.
For beneficiaries with income slightly above the free Medi-Cal threshold, California offers "Medi-Cal with share of cost." These enrollees must pay medical expenses up to a monthly threshold before Medi-Cal begins paying. Once a member reaches their share of cost, the managed care plan covers remaining approved services for that month.
“Since provider networks are the main meaningful distinction between plans at the state level—all cover the same services with no cost sharing—identifying which doctors and hospitals participate in each plan is the most important factor in choosing.”
Special plans for specific populations
Medi-Cal also operates specialty managed care plans for particular groups. PACE (Program of All-Inclusive Care for Elderly) serves beneficiaries aged 55 and older and provides comprehensive services including adult day care and care coordination, often at lower cost. Dual-eligible individuals with both Medi-Cal and Medicare can enroll in Medi-Medi plans, which coordinate benefits between the two programs. Medi-Medi plans are available in certain counties for voluntary enrollment.
Kaiser Permanente operates integrated delivery and insurance systems in several counties. This closed-network model differs from traditional managed care plans, which contract with independent providers.
How to choose a plan
For those in Two-Plan counties, the choice between the Local Initiative plan and the commercial plan hinges on network preferences. Some prefer the commercial plan's network; others prioritize the safety-net focus and public provider ties of the Local Initiative plan. In GMC counties like San Diego, multiple commercial options exist, and members might compare plan features and reputations. In COHS counties, the state makes the choice, though members can request enrollment changes during certain periods.
The state maintains a plan directory by county and updated plan information at dhcs.ca.gov, where beneficiaries can compare specific plans and their providers. Since provider networks are the main meaningful distinction between plans at the state level—all cover the same services with no cost sharing—identifying which doctors and hospitals participate in each plan is the most important factor in choosing.
Related coverage: How Medi-Cal eligibility works, and what it covers; How Covered California works, and who it is actually for.
