Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements and is jointly funded by states and the federal government. California’s Medicaid program is known as Medi-Cal.
Membership
More than 1.1 million members are enrolled with or assigned to Kaiser Permanente in Medicaid (called Medi-Cal in California).
Participation
Kaiser Permanente participates in Medi-Cal in 32 counties in California.
Our Care
Effective January 2024, Kaiser Permanente entered a direct contract with the California Department of Health Care Services as part of the state’s long-term plan to transform and improve the quality of the Medi-Cal program. This contract enables us to provide coverage and care for Medi-Cal enrollees where Kaiser Permanente has a commercial footprint, comprised of 32 California counties. Our coverage reduces complexity and confusion for Medi-Cal enrollees and results in less fragmented care.
Quality
Kaiser Permanente performs highly on measures of quality and has the had the highest ratings of any commercial Medi-Cal managed care plan in the state.
Kaiser Permanente performs in the National Committee for Quality Assurance (NCQA®) 90th percentile or above** for the following measures for Medi-Cal members:
- Breast Cancer Screening
- Cervical Cancer Screening
- Colorectal Cancer Screening
- Blood Pressure Control
- A1C Control for Patient with
- Diabetes
- Eye Exam for Patients with Diabetes
- Asthma Medication Ratio
- Childhood Immunization Status Combo 3
- Immunizations for Adolescents Combo 2
These metrics are based on NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS), a tool used by more than 90% of America’s health plans to measure performance on important measures of care and service.
(*Measures reflect Kaiser Permanente Medi-Cal performance among all Medicaid plans nationally in 2023. 2024 results for Kaiser Permanente’s Direct Contract across 32 counties are pending.)
Dual Eligibility in Medi-Cal and Medicare
Dual Eligibles are those who can participate in both Medi-Cal and Medicare programs, and Kaiser Permanente serves roughly 180,000* Dual Eligibles across the state. In recent years, there is an elevated need for Dual Eligibles to enroll in Dual Eligible Special Needs Plans (D-SNP), which offer extra benefits and no extra fees to the member. We serve Dual Eligibles in both D-SNPs and traditional Medicare Advantage plans. (*Data current as of November, 2024).
State Program Spotlight
Kaiser Permanente provides several Medi-Cal benefits that help address social needs and improve outcomes for our members, especially those with the most complex needs. Key benefits include:
Enhanced Care Management (ECM): a benefit that provides person-centered, community-based care management to the highest need members. This benefit allows care managers to meet members where they are to address their needs, including on the street, in a shelter, in the doctor’s office, or at home. Through ECM, members can be connected to Community Supports services to help address their health-related social needs, such as access to healthy foods or safe housing to help with recovery from an illness.
Community Supports (CS): services that address health-related social needs, and help people live healthier lives, and avoid higher, costlier levels of care; examples include medically tailored meals and housing assistance. The Kaiser Permanente Community Support Hub™ operates proactively, using text, email, and phone calls to encourage members to complete social health screenings and to offer help finding and enrolling in community-based resources and government assistance programs. The Hub also provides on-demand services, including an online directory of resources that anyone can use to search for local programs that help with housing, food, paying utility bills, and more.
Community Health Worker (CHW) Services: preventive health services to prevent disease, disability, and other health conditions or their progression; to prolong life; and promote physical and mental health and well-being; CHW services may be provided by individuals known by a variety of job titles, including promotores, community health representatives, navigators, and other non-licensed public health workers, including violence prevention professionals.
Doula Services: includes emotional and physical support provided during pregnancy, labor, birth, and the postpartum period, as well as support for and after miscarriage and abortion.
Kaiser Permanente serves children in Medi-Cal and has recently expanded the following:
- Whole Child Model: a program that integrates California Children’s Services benefits into a child’s Medi-Cal managed care, allowing for better coordinated care of all medical needs through a single system; Kaiser Permanente expanded participation to 12 counties as of 2025.
- Foster Youth and Former Foster Youth: Kaiser Permanente’s Foster Youth Model of Care supports the many foster youth and former foster youth who are eligible for Medi-Cal within our footprint without meeting any other criteria. In 2025, Kaiser Permanente will serve additional foster youth in 3 counties where the state has required their enrollment into Medi-Cal managed care.
Social Health
Many Kaiser Permanente members struggle with inadequate housing, hunger, financial stress, and other circumstances that create barriers to good health, particularly members enrolled in Medi-Cal. Kaiser Permanente works proactively to identify our members with adverse social needs and to connect them to community-based programs and government assistance-programs that can support their well-being.
Safety-Net Partnerships
Kaiser Permanente is committed to building partnerships with the health care “safety net” — institutions that play a critical role in delivering health care for the uninsured and underserved. Through grants, training, and technical assistance, we work with safety-net hospitals and health centers to help these institutions reach people who are low-income, uninsured, or under-resourced in our communities, and to move the needle in eliminating health disparities. We do this by investing in quality improvement and other support efforts that aim to transform care and improve health access for those most in need.
Social Health Screening and Identification
Kaiser Permanente uses standard social health screening questions and data analytics to identify members vulnerable to food-insecurity, homelessness, financial strain, and other adverse social factors. By expanding social health screenings across an increasing number of clinical settings and member service touchpoints, with a focus on high-risk populations, Kaiser Permanente is steadily increasing the number of members screened for social needs each year. We screened nearly 3 million members for social needs in 2024, including 32% of our Medicaid members. These screenings and other data sources helped us identify over 1 million members with social needs and connect nearly 500,000 members to public benefits and community-based programs that support overall health.
Medical Legal Partnerships
Working with local legal aid organizations in our communities, our care teams help patients facing housing-insecurity receive legal help at no cost. These medical-legal partnership programs build the capacity of the legal services sector and increase access to legal services to prevent people and families from losing their homes. This program targets low-income members and patients with housing related legal needs. In 2024, legal consultation was provided to over 1,000 patients.