California county-based health plans are public entities organized in one or more counties to provide Medi-Cal enrollees and, in some cases, county employees and California-covered enrollees, with comprehensive managed care. Most county-based health plans are independent public agencies organized under California law as local initiatives or county-organized health systems. These plans cover one in five Californians. Learn about these plans: what they are, where they work, and how their enrollment and finances have changed over the past few years.

Strong points

All county-based plans combined

Registrations (declared at the end of June) increased slightly (1.1%) in 2020.

Revenues increased in 2019 and 2020, a reversal from their decline in 2018.

Margins narrowed from 2018 to 2020, and they were less than half the level of margins in the previous five years. The overall margin in 2020 was 0.3%. Revenue growth (5.7%) was offset by higher medical (8.1%) and administrative (6.4%) expenses (not shown).

Health plan details

Rising medical and administrative costs have eroded margins for most plans.

In 2020, registrations increased for 12 plans. Revenues increased in 2020 for 13 of the 16 plans. Despite enrollment and revenue increases for most plans in 2020, the average margin in 2020 (0.3%) remained below the 10-year average (2.3%). In 2019 and again in 2020, 6 of the 16 plans lost money, compared to 4 in 2018.

Where county-based plans work

Scroll through a county to find out which plan is available. Counties mapped in gray do not have a county-based plan.

The data file and individual graphs are available for download below. These documents are part of the CHCF’s California Health Care Almanac, an online clearinghouse of key data and analysis describing the state’s health care landscape. View our comprehensive collection of current and past editions of California Health Insurers and Enrollment.

Notes: Enrollment figures are from June. The turnover, the net profit and the margin reflect the annual results of the financial year. All growth is annual. The Contra Costa Health Plan and Valley Health Plan include both Medi-Cal enrollees and county employees; The Ventura County Health Care Plan was created to serve county employees and their dependents. Data was not available for the Gold Coast Health Plan, which is Ventura County’s Medi-Cal managed care plan.

Source: “Health Plan Financial Summary Report” (2012–21), California Dept. of Managed Health Care.