Revised May 20, 2014 Using MIS-DSS Data
0
Research and Analytic Studies Division
MEDI-CAL MONTHLY ENROLLMENT FAST FACTS Characteristics of the Medi-Cal population as captured by the Medi-Cal Eligibility Data System (MEDS)
The enrollment data included in this document represent only certified eligible counts. Certified eligibles are those beneficiaries deemed qualified for Medi-Cal by a valid eligibility determination, and who have enrolled into the program. This classification excludes beneficiaries who have a monthly share-of-cost obligation that has not been met, as well as other specific populations. Enrollment counts exclude information related to applications received or any other eligibles that may be in the process of becoming certified eligible.
The counts presented are considered PRELIMINARY and subject to change. The certified eligible counts reflected in this document incorporate three Medi-Cal eligibility updates and reflect roughly 99.2% of all Medi-Cal certified eligibles for the most recent month displayed. A specific month’s enrollment count is considered complete for statistical reporting purposes 12 months after the month’s end.
June 2016 As of the MEDS Cut-off
for September 2016
Department of Health Care Services, Research and Analytic Studies Division 1
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
7,864,9658,605,691
13,570,391
01,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,0008,000,0009,000,000
10,000,00011,000,00012,000,00013,000,00014,000,00015,000,000
Cert
ified
Elig
ible
s
Month
Figure 1: Medi-Cal Certified Eligibles, January 2013 through June 2016
1,207,687 1,237,869
1,399,689
759,220 762,319 743,988
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
Cert
ified
Elig
ible
s
MonthDual Medi-Cal Only SPD
Figure 2: Medi-Cal Certified Eligibles – Dual Eligibles & Medi-Cal-Only Seniors and Persons with Disabilities (SPDs), January 2013 through June 2016
Department of Health Care Services, Research and Analytic Studies Division 2
Figure 3: Medi-Cal Certified Eligibles by Aid Category, June 2016*
Figure 4: Gender
Figure 5: Age Group***
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
3,688,864
157,702
1,310,666
54,461
168,480
5,490,854
2,003,112
696,252
- 2,000,000 4,000,000 6,000,000
ACA Expansion Adult – Ages 19 to 64
Adoption/Foster Care
CHIP
LTC**
Other
Parent/Caretaker Relative & Child
Seniors and Persons with Disabilities
Undocumented
Certified Eligibles
Aid
Cate
gory
5%
15%
40%
1%
<1%
10%
1%
27%
Female7,270,835
54%
Male6,299,556
46%
13,570,3910-20
5,709,89642%
21-646,741,143
50%
65+1,119,352
8%
13,570,391
*Refer to the Appendix for detailed aid code groupings. **Individuals residing in a long-term care facility. ***Seven certified eligibles without age data were grouped in the “0-20” age cohort.
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
Department of Health Care Services, Research and Analytic Studies Division 3
Figure 6: Race/Ethnicity
Figure 7: Delivery System
Figure 8: Dual Status
Figure 9: ACA Expansion Adult – Ages 19 to 64
Asian/ Pacific
Islander1,733,179
13%
African American1,028,149
8%
Hispanic6,461,324
48%
Not Reported1,558,981
11%
American Indian/ Alaskan Native56,682
<1%
White2,732,076
20%13,570,391
Fee-for-Service
2,883,13121%
13,570,391
Managed Care
10,687,26079%
Dual1,399,689
10%
13,570,391
Non-Dual12,170,702
90%
ACA Expansion
Adult -Ages 19
to 643,688,864
27%
All Other Aid
Categories9,881,527
73%
13,570,391
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
Department of Health Care Services, Research and Analytic Studies Division 4
Figure 10: Medi-Cal Enrollees by Delivery System, January 2013 through June 2016
Figure 11: Aid Group for Fee-for-Service Participants
Figure 12: Aid Group for Managed Care Participants
2,801,272 2,505,614
2,883,131
5,063,6936,100,077
10,687,260
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
10,000,000
11,000,000
12,000,000
Cert
ified
Elig
ible
s
MonthFee-for-Service Managed Care
Undocumented 695,612
24%
Parent/CaretakerRelative & Child
709,56525%
SPD473,470
16%
Other151,329
5%
Adoption/Foster Care97,0623% CHIP
83,8013%
LTC28,179
1%
ACA Expansion
Adult –Ages 19 to
643,044,751
28%
Adoption/ Foster Care
60,6401%
CHIP1,226,865
11%
LTC26,282
<1%
Other17,151
<1%
Parent/ Caretaker Relative &
Child4,781,289
45%
SPD1,529,642
14%Undoc-
umented640<1%
10,687,2602,883,131
ACA Expansion Adult – Ages 19 to 64
644,113 22%
Department of Health Care Services, Research and Analytic Studies Division 5
Figure 13: Language
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
English8,380,828
62%
Spanish4,069,085
30%
Unknown152,328
1%
Armenian74,579
1%
All Chinese**262,229
2%
Vietnamese223,156
2%
All Other*408,186
3%Other968,150
7%
Total = 13,570,391
905,4494,485,236
8,630,920
9,002,3087,884,190
4,939,471
9,907,757
12,369,426
13,570,391
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
Figure 14: Medi-Cal Certified Eligibles, MAGI and Non-MAGI, January 2014 through June 2016
MAGI Non-MAGI Grand Total
Month
Cert
ified
Elig
ible
s
Note: Many certified eligibles in Non-MAGI aid codes are transitioned into MAGI aid codes during the redetermination process.
*“All Other” includes: ASL, Arabic, Cambodian, Farsi, French, Hebrew, Hmong, Ilocano, Italian, Japanese, Korean, Lao, Mien, Other Non-English, Other Sign, Polish, Portuguese, Russian, Samoan, Tagalog, Thai, and Turkish. **“All Chinese” includes certified eligibles who indicated their primary language as Mandarin, Cantonese, or “Other Chinese.”
Department of Health Care Services, Research and Analytic Studies Division 6
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
MAGI8,630,920
64%
Non-MAGI4,939,471
36%
Figure 15: Medi-Cal Certified Eligibles by MAGI Status
13,570,391
Male4,064,761
47%
Female4,566,159
53%
Figure 16: Gender for MAGI
8,630,920 Female2,704,676
55%
Male2,234,795
45%
Figure 17: Gender for Non-MAGI
4,939,471
Department of Health Care Services, Research and Analytic Studies Division 7
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
0-203,631,250
42%
21-644,994,452
58%
65+**5,218<1%
Figure 18: Age Group for MAGI*
8,630,9200-20
2,078,64642%
21-641,746,691
35%
65+1,114,134
23%
Figure 19: Age Group for Non-MAGI***
4,939,471
1,102,952
2,675,030
3,688,864
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
Figure 20: ACA Expansion Adult – Ages 19 to 64, Since January 2014
ACA
Expa
nsio
nAd
ults
Age
s 19-
64
Month
*Four certified eligibles categorized as MAGI and without age data were grouped in the “0-20” age cohort. **Some MAGI aid codes do not have age restrictions. ***Three certified eligibles categorized as Non-MAGI and without age data were grouped in the “0-20” age cohort.
Department of Health Care Services, Research and Analytic Studies Division 8
Figure 21: ACA Expansion Adult – Ages 19 to 64 – Gender
Figure 22: ACA Expansion Adult – Ages 19 to 64 – Age Group
Figure 23: ACA Expansion Adult – Ages 19 to 64 – Race/Ethnicity
Figure 24: ACA Expansion Adult – Ages 19 to 64 – Delivery System
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
Female1,796,801
49%
Male1,892,063
51%3,688,864
0-20243,899
7%
21-643,444,965
93%
3,688,864
American Indian/ Alaskan Native18,417
1%
Asian/ Pacific
Islander631,181
17%
African-American289,299
8%
Hispanic1,378,809
37%White951,737
26%
3,688,864
Not Reported419,42111%
Fee-for-Service644,113
17%
Managed Care
3,044,75183%
3,688,864
Department of Health Care Services, Research and Analytic Studies Division 9
Figure 26: ACA Expansion Adult – Ages 19 to 64 – Language
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
55,9481%
110,9083%
3,181,750 86%
317,8369%
22,602 1%
Figure 25: ACA Expansion Adult – Ages 19 to 64 – Aid Code
7U-Express Lane Enroll(XIX) Adults Ages 19–64 FS No SOC
L1-LIHP/MCE transition to Medi-Cal
M1-Adult 19 to 64 at or below 138%FPL Citizen/Lawful
M2-Adult Undoc 19-<65, 0-138% FPL
P3-Hospital PE Adult, 0-138% FPL
Total =3,688,864
English2,614,784
71%
Spanish810,836
22%
Unknown4,217 <1%
All Chinese**83,697
2%Korean20,165
1%
Vietnamese72,403
2%
All Other*82,762
2%Other259,027
7%
Total = 3,688,864
*All Other” includes: ASL, Arabic, Armenian, Cambodian, Farsi, French, Hebrew, Hmong, Ilocano, Italian, Japanese, Lao, Mien, Other Non-English, Other Sign, Polish, Portuguese, Russian, Samoan, Tagalog, Thai, and Turkish. **“All Chinese” includes those who indicated their primary language as Mandarin, Cantonese, or “Other Chinese.”
Department of Health Care Services, Research and Analytic Studies Division 10
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
Appendix 1 Table 1: Medi-Cal Aid Categories and Aid Codes
Aid Category Corresponding Primary Aid Codes ACA Expansion Adult - Ages 19 to 64*
7U, L1, M1, P3
Adoption/Foster Care 03, 04, 06, 07, 40, 42, 43, 45, 46, 49, 2P, 2R, 2S, 2T, 2U,4A, 4E, 4F, 4G, 4H, 4L, 4M, 4N, 4S, 4T, 4W, 5K
CHIP
5C, 5D, 5E, 7X, 8P, 8R, 8X, E2, E6, E7, H0, H1, H2, H3, H4, H5, H6, H9, L2, L4, M5, T1, T2, T3, T4, T5
LTC 13, 23, 53, 63 Other
01, 02, 08, 0A, 0L, 0M, 0N, 0P, 0R, 0T, 0U, 0V, 0W, 0X, 0Y, 2A, 2V, 44, 4K, 4V, 5V, 65, 71, 73, 76, 77, 7F, 7G, 7H, 7M, 7N, 7P, 7R, 7V, 81, 82, 83, 86, 87, 8E, 8W, 90, F1, F2, F3, F4, F5, F6, F7, F8, G0, G1, G2, G3, G4, G5, G6, G7, G8, G9, J1, J2, J3, J4, J5, J6, J7,J8, M9, N0, N5, N6, N7, N8, N9, R1
Parent/Caretaker Relative & Child
3N, 30, 32, 33, 34, 35, 37, 38, 39, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3P, 3R, 3U, 3W, 47, 54, 59, 5X, 6R, 72, 7A, 7J, 7S, 7T, 7W, 8U, 8V, H7, H8, K1, M3, M7, P1, P2, P4, P5, P7, P9
Seniors and Persons with Disabilities
10, 14, 16, 17, 18, 1E, 1H, 1X, 1Y, 20, 24, 26, 27, 28, 2E, 2H, 36, 60, 64, 66, 67, 68, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6S, 6V, 6W, 6X, 6Y, 8G
Undocumented
1U, 3T, 3V, 48, 55, 58, 5F, 5H, 5J, 5M, 5N, 5R, 5T, 5W, 5Y, 69, 6U, 70, 74, 7C, 7K, 8N, 8T, C1, C2, C3, C4, C5, C6, C7, C8, C9, D1, D2, D3, D4, D5, D6, D7, D8, D9, L3, L5, M0, M4, M6, M8, P0, P6, P8, T0, T6, T7, T8, T9
*Although the M2 aid code is specified for Undocumented immigrants, this publication includes M2 in the ACA Expansion Adult – Ages 19 to 64 group. For this publication, this population was categorized using the following aid codes: 7U, L1, M1, M2, and P3.
Note: Aid category groupings were established by RASD and are used for analytical purposes only. They do not necessarily represent specific distinctions between eligibility criteria, funding sources, or any other differentiating characteristics.
Department of Health Care Services, Research and Analytic Studies Division 11
June 2016 Certified Eligible Statistics – Medi-Cal Population As of the MEDS Cut-off for September 2016
Appendix 2
Table 2: Aid Codes by MAGI Status
MAGI Status Corresponding Primary Aid Codes MAGI 59, 5T, 7J*, 7K*, 8E, E2, E6, E7, M0, M1, M2, M3, M4, M5, M6, M7, M8,
M9, N5, N6, N7, N8, P0, P5, P6, P7, P8, P9, T0, T1, T2, T3, T4, T5, T6, T7, T8, T9
Non-MAGI 01, 02, 03, 04, 06, 07, 08, 0A, 0L, 0M, 0N, 0P, 0R, 0T, 0U, 0V, 0W, 0Y, 10, 13, 14, 16, 17, 1E, 1H, 1U, 1X, 1Y, 20, 23, 24, 26, 27, 2A, 2E, 2H, 2P, 2R, 2S, 2T, 2U, 2V, 30, 32, 33, 34, 35, 36, 37, 38, 39, 3A, 3C, 3D, 3E, 3F, 3G, 3H, 3L, 3M, 3N, 3P, 3R, 3T, 3U, 3V, 3W, 40, 42, 43, 44, 45, 46, 47, 48, 49, 4A, 4E, 4F, 4G, 4H, 4K, 4L, 4M, 4N, 4S, 4T, 4V, 4W, 53, 54, 55, 58, 5C, 5D, 5E, 5F, 5H, 5J, 5K, 5M, 5R, 5V, 5W, 60, 63, 64, 66, 67, 69, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6R, 6S, 6U, 6V, 6W, 6X, 6Y, 71, 72, 73, 74, 76, 77, 7A, 7C, 7F, 7G, 7H, 7M, 7N, 7P, 7R, 7S, 7T, 7U, 7W, 81, 82, 83, 86, 87, 8G, 8N, 8P, 8R, 8T, 8U, 8W, 8X, 90, C1, C2, C3, C5, C6, C7, C8, C9, D1, D2, D3, D4, D5, D6, D7, D8, D9, F1, F2, F3, F4, G1, G2, G3, G5, G6, G9, H0, H1, H2, H3, H4, H5, H6, H7, H8, H9, J3, J7, K1, L1, N0, N9, P1, P2, P3, P4, R1
*Aid codes 7J and 7K are both MAGI and Non-MAGI. For the purposes of analysis these aid codes have been included in the MAGI category only.
If You Plan To Cite this Paper in a Subsequent Work, We Suggest the Following Citation:
Research and Analytic Studies Division, September 2016. Medi-Cal Monthly Enrollment Fast Facts, June 2016. California Department of Health Care Services.
Legal Disclaimer:
Please note that this document provides a brief summary of complex subjects and should be used only as an overview and general guide to the Medi-Cal program. The views expressed herein do not necessarily reflect the policies or legal positions of the California Health and Human Services Agency (CHHS) and the California Department of Health Care Services (DHCS). These summaries do not render any legal, accounting, or other professional advice, nor are they intended to explain fully all of the provisions or exclusions of the relevant laws, regulations, and rulings of the Medicare and Medicaid programs. Original sources of authority should be researched and utilized.