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On July 30, 1965, President Lyndon B. Johnson signed the Medicare and Medicaid Act, a historic occasion that has been remodeling the well being and lives of tens of millions of Americans for 60 years.
While Medicare was established as a federally administered medical insurance program for older Americans, Medicaid was arrange as an non-obligatory state-run insurance coverage program for folks with low incomes, and it was funded with not less than 50% of this system’s prices paid for by the federal authorities.
Several months later, California’s legislature voted overwhelmingly in favor of making its personal Medicaid program, and it was signed into legislation by Governor Edmund G. “Pat” Brown.
The following yr, Medi-Cal opened for enterprise.
Overnight, a million Californians — 6% of the inhabitants — grew to become eligible for enrollment in a publicly funded medical insurance program protecting hospital and emergency companies, main and preventive care, dental care, psychiatric care, and prescribed drugs.
As the state faces ongoing financial and political challenges, you will need to acknowledge how Medi-Cal helps the well being and stability of California at this time and why its ongoing enchancment is essential to a extra affluent future.
In the early Nineteen Sixties, nearly 30% of the population was uninsured. Among these with insurance coverage, most had coverage for hospital or surgical care paid for by their employer. Very few Americans had insurance coverage for main care.
Before Medicaid handed, the US infant mortality charge was 25 deaths per 100,000 stay births, and the maternal mortality charge for deaths associated to being pregnant was 33 per 100,000. Today, toddler mortality is 5 per 100,000 live births, whereas maternal mortality has fallen to 18 per 100,000. These two well being indicators are notably related since Medicaid now covers 41% of births nationwide. While toddler and maternal mortality, like all well being outcomes, are formed by elements past well being protection, these tendencies characterize progress value celebrating at the same time as we acknowledge enchancment is required.
“There is another tradition that we share today. It calls upon us never to be indifferent toward despair. It commands us never to turn away from helplessness. It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.”
President Lyndon B. Johnson, 1965
In its early days, eligibility for Medi-Cal was based mostly on an individual’s family earnings. Only Californians who certified for money help had been eligible to enroll, together with folks with disabilities and households with dependent youngsters. For these Californians, the advantages had been life altering, as a result of folks with low incomes or with out medical insurance had been then — and stay at this time — extra prone to expertise persistent illness and different well being challenges.
But the construction of Medi-Cal additionally perpetuated dangerous stereotypes about who does and doesn’t deserve well being care, and it left vital populations out of this system. Working households that earned greater than the federal poverty stage (FPL) however not sufficient to afford non-public insurance coverage, immigrants, and adults with low incomes however with out dependent youngsters (together with pregnant girls) had been all ineligible.
Poverty and Medi-Cal
Federal poverty stage (FPL) pointers had been launched in 1966 to find out eligibility for presidency applications, however family earnings thresholds had been so low that many Californians who couldn’t afford non-public medical insurance didn’t qualify for money help — and had been due to this fact ineligible to enroll in Medi-Cal. Today, requirements have been expanded to family incomes of 138% of FPL for many single adults ($21,597), 213% of FPL for particular person expectant moms and pregnant folks ($33,335), and 266% of FPL for youngsters (that means the restrict for a household of three is $70,899). Still, these nationwide earnings pointers stay low, particularly for these residing in high-cost states like California.
“When you’re poor, you also typically have poorer health. Getting them access to services that they haven’t had access to makes a difference.”
Colleen Grogan, Medicaid scholar
In the final 60 years, California has made immense strides in decreasing well being disparities by extending protection to extra populations. Seeing the benefits provided by inexpensive well being care and dependable protection, and when given the chance by means of adjustments in federal legislation, state legislators progressively added tens of millions of enrollees by increasing eligibility guidelines.
Today, virtually 40% of Californians depend on Medi-Cal for a variety of companies, together with main and specialty care; hospital care; behavioral well being; dental companies; long-term care, together with assisted residing, expert nursing care, and in-home care; and health-related social companies, akin to housing navigation helps, residence modifications for folks with disabilities, and meal help.
“From mothers, children, and families, to adults with disabilities and chronic illness, to unhoused and at-risk neighbors, to seniors living in a variety of settings, so many of us are stronger and healthier because we have the ability to receive the care we need.”
Medi-Cal enrollee, Los Angeles County
- Medi-Cal is standard, with almost 6 in 10 Californians saying Medi-Cal works properly.
- More than half of Californians have a connection to Medi-Cal and report that somebody near them has benefited from a Medi-Cal service.
- Medi-Cal’s enchantment crosses occasion strains. More than 9 in 10 Californians say Medi-Cal is essential to the state, together with 98% of Democrats, 85% of Republicans, and 83% of Independents.
Source: Poll Explores Californians’ Attitudes on Medi-Cal, Covered California, and Federal Cuts to Both, CHCF, March 3, 2025.
Better Coverage and Care for More Californians
Over the previous 60 years, Medi-Cal has advanced right into a mainstay of California’s well being care security internet, providing care and financial safety to tens of millions of individuals and bettering the well being of communities up and down the state.
From eradicating eligibility restrictions for inexperienced card holders within the Nineties to elevating enrollment asset limits so older adults can obtain long-term care companies whereas retaining financial savings, California has been a nationwide chief in constructing a extra inclusive and efficient Medicaid program — and a more healthy state.
Legislative choices to increase eligibility have been key to Medi-Cal’s progress. These embrace:
- 1988: Expansions for pregnant girls. Before this laws, expectant moms with out dependent youngsters had been unable to qualify for money help and due to this fact excluded from Medi-Cal.
- 1997: Adoption of Children’s Health Insurance Program (CHIP). Coverage expanded for youngsters whose household earnings exceeds the Medicaid threshold. The program additionally funded California’s Healthy Families Program, which was folded into Medi-Cal in 2013.
- 2014: Implementation of the Affordable Care Act (ACA). The ACA allowed Medi-Cal to increase protection to most adults with low incomes however with out dependent youngsters or disabilities. The federal authorities pays 90% of prices for brand spanking new enrollees. In simply two years, 5 million extra Californians had been insured. California’s uninsured charge fell from 17% earlier than the ACA to a document low 6.4% in 2023.
- Since 2015: Expansions for income-eligible folks no matter immigration standing. Immigrants with out authorized standing grew to become California’s largest uninsured group after the ACA took impact. Beginning in 2015, the state progressively lifted restrictions that excluded undocumented Californians, utilizing state funds to open enrollment to all income-qualifying residents no matter authorized standing. In 2025, California barred new enrollment for grownup undocumented immigrants, efficient in 2026. Those who enrolled previous to 2026 can keep in this system, however they are going to be required to pay a brand new month-to-month premium.
“Medi-Cal has allowed me to use the small amount of money I am able to earn for my rent and expenses rather than strictly on health care. If I had to pay for the prescriptions, tests, and doctor visits my chronic illness requires, I would not be able to afford even my most basic needs.”
ACA growth Medi-Cal enrollee, Los Angeles County
In 2022, California launched CalAIM (California Advancing and Innovating Medi-Cal), a revolutionary initiative aimed toward bettering take care of Medi-Cal enrollees, particularly these with complicated wants. Target teams embrace folks with complicated behavioral well being wants, older adults, folks with disabilities, people who’re or have been concerned with the legal justice system, and youngsters and youth in foster care. CalAIM is made attainable by particular Medicaid waivers that generate federal {dollars} to mix with state funds to offer essential social and medical companies.
Strengthening California for All
In its six many years, Medi-Cal has improved lives, diminished well being disparities, and strengthened the economies of all 58 counties in California. The program has been vital in making certain that each one California youngsters, older adults with low incomes, and folks with disabilities get the protection and care they should lead wholesome lives. By bettering their well being, Medi-Cal has made California a stronger state for all.
“We wouldn’t have a safety net if it weren’t for Medi-Cal.”
Stan Rosenstein, former Medi-Cal director
Medi-Cal and Children
Medi-Cal has all the time served youngsters from low-income households and people with complicated medical wants. Thanks to eligibility expansions focusing on middle-income and immigrant households no matter authorized standing, greater than half of California’s youngsters at the moment are coated by Medi-Cal. This has enabled California’s uninsured charge for youngsters to fall properly under the nationwide common. These successes are partly the results of eligibility expansions that allow mother and father and caregivers to enroll. The key indicator of a kid being insured is that if an grownup in that family has protection as properly.
“We know that children who have Medicaid do better in school. They’re less likely to be absent. They’re more likely to graduate high school. They’re more likely to go to college. They’re more likely to earn more money as adults than kids who didn’t have health insurance. It’s truly an investment in who we are as people, as Americans.”
Mayra Alvarez, president of The Children’s Partnership
“If we didn’t have Medi-Cal, my son wouldn’t have any services to help him in school. He’s had extra speech, physical therapy. That’s how he was able to crawl, walk, [and] progress.”
Natalie, guardian of a Medi-Cal enrollee with autism, Orange County
Medi-Cal and Seniors
Adults over 65 have been a key inhabitants since Medi-Cal’s inception. More than a million Californians over age 65 are enrolled at this time. Their Medi-Cal advantages fill essential gaps in companies coated by Medicare. Most notably, they’re eligible for long-term care advantages. Medi-Cal is the first payer for greater than 60% of California nursing residence residents. For older adults enrolled in each Medi-Cal and Medicare, Medi-Cal covers the often-prohibitive price of Medicare month-to-month premiums.
“I don’t think the lawmakers understand how difficult it is for those of us who live on a limited income. Medi-Cal has my back. They’re there for me. And I know that I can take better care of my health. Medi-Cal has allowed me to enjoy life. Without it, I’d be financially sunk.”
Wendy, 65+ Medi-Cal enrollee, Riverside County
Removing Unfair Barriers to Care
Medi-Cal is a lifeline for traditionally underserved teams, together with these with disabilities, rural residents, and folks of colour. Recent knowledge present that 29% of Black Californians and 40% of Latino/x Californians beneath the age of 65 are enrolled in Medi-Cal. Extending protection to all income-eligible residents no matter immigration standing dramatically improved entry to take care of undocumented folks previous to the 2025 rollbacks. Recent initiatives, most notably these beneath CalAIM, have launched companies geared to teams that face a few of the biggest obstacles to care, together with folks experiencing homelessness, folks with extreme psychological sickness and behavioral well being wants, and folks launched from jails or prisons.
“I had barely even seen a doctor before I got on Medicaid.… [But] once I got hooked up with them and everything got going, I got healthy.”
Michael, previously unhoused Medi-Cal enrollee, Santa Barbara County
Medi-Cal and the Economy
Medi-Cal is considered one of California’s most essential financial engines, immediately supporting a whole bunch of hundreds of jobs statewide in well being care, know-how, building, and meals companies. It can be credited with rising the retail, restaurant, and actual property sectors of the state financial system as a result of well being care staff spend their wages on items and companies. Medi-Cal allows employed Californians — particularly low-wage and hourly staff — to remain wholesome and on the job. In 2023, greater than 60% of Medi-Cal enrollees had been employed, whereas almost one in 5 folks age 19 to 64 within the California labor drive was enrolled in Medi-Cal.
“Having health insurance improves people’s ability to gain and maintain employment. And when providers have more insured patients, they’re better able to predict their revenues and have financial stability. This benefits all of us.”
Laurel Lucia, UC Berkeley Labor Center
Medi-Cal: A Legacy to Build On
For 60 years, Medi-Cal has steadily enabled an increasing number of Californians to get the care they should get pleasure from full and productive lives, which makes the state higher for all of us. The Medi-Cal program has achieved this by overcoming important obstacles, together with hospital closures, workforce shortages, and funding cuts.
The program continues to face new challenges. In July 2025, Congress and the president enacted almost $1 trillion in cuts to Medicaid over the subsequent 10 years — the biggest funding discount in this system’s historical past. These cuts threaten entry to take care of tens of millions of Californians. At the identical time, state funds challenges have triggered California to reinstate some prior restrictions on Medi-Cal eligibility associated to immigration standing.
In the face of those obstacles, our well being care leaders and policymakers should work collectively to protect Medi-Cal’s legacy of deep dedication to the well-being of Californians who want a serving to hand. All of us — policymakers, well being plans, suppliers, neighborhood organizations, and philanthropy — have an important position to play in its future.
“Medi-Cal stands as a landmark achievement that embodies our shared values and collective progress,” stated Sandra R. Hernández, MD, President and CEO of the California Health Care Foundation. “Honoring Medi-Cal this year is not just reflection — it is a call to action. By embracing its accomplishments and the enduring strength of this social contract, we pass the torch to future generations of leaders to fulfill Medi-Cal’s promise in the decades to come.”
Authors & Contributors
Robin Buller
Freelance author, researcher, and editor
Robin Buller is an Oakland-based author, researcher, and editor. She has reported on hurt discount, maternal well being, migration, housing, and policing for The Guardian, The Oaklandside, and different publications. Originally from Canada, Buller holds a doctorate in historical past from UNC Chapel Hill.
Jessica Brandi Lifland
Freelance photographer
Jessica Brandi Lifland is a contract photographer, teacher of journalism at City College of San Francisco, and mom.
This web page was created programmatically, to learn the article in its unique location you may go to the hyperlink bellow:
https://www.chcf.org/resource/60-years-of-medicaid/
and if you wish to take away this text from our website please contact us
