The State of Enrollment in California
Access to health coverage is foundational to health, economic stability and well-being.
We joined forces with Transform Health to better understand the barriers preventing eligible Californians from enrolling in and maintaining coverage. Behind every enrollment gap is a person or family who may struggle to access care, manage a chronic condition or afford an unexpected health crisis. At a time of significant federal and state policy changes, we collaborated on The State of Enrollment in California, a report that provides a roadmap for strengthening outreach, enrollment and retention efforts and advancing health equity statewide.
About the Report
Commissioned by Sierra Health Foundation and authored by Transform Health, The State of Enrollment in California examines the state’s long-standing commitment to expanding access to health coverage and provides a historical look at enrollment in Medi-Cal, California’s Medicaid program, and the evolution of coverage over time.
The paper also offers recommendations to strengthen outreach, enrollment and retention efforts so that more Californians can access and maintain the coverage they need.
Enrollment Landscape Highlights
14 million+
Californians
are enrolled in Medi-Cal; that’s one in three residents across the state
California’s 5.9% uninsured rate
is at risk, after falling by nearly two-thirds since 2008
2 million
Californians
may lose Medi-Cal coverage due to new federal reporting requirements
The State of Enrollment
California has made significant investments over decades to simplify health coverage enrollment, including efforts to create a “No Wrong Door” system that helps people access benefits through simplified enrollment processes. Yet many eligible individuals continue to face administrative barriers that make it difficult to enroll in or maintain Medi-Cal coverage. When people lose coverage or cannot successfully enroll, they are more likely to delay seeking timely medical help, resulting in poorer health outcomes and higher health care costs.
Navigating the health insurance system remains complex, and many individuals rely on trusted support to enroll in and retain coverage. The need for effective enrollment assistance is especially important as federal policy changes and state budget decisions reshape Medi-Cal eligibility, financing and administration.
The State of Enrollment in California highlights the role that funders, Medi-Cal managed care plans, providers, counties, state agencies and community-based organizations can play in helping Californians access and maintain health coverage. It offers opportunities to strengthen the systems, workforce and communications infrastructure that support enrollment and retention, helping preserve and build on the coverage gains California has worked so long to achieve.