Medi-Cal and Fee-For-Service Expenditures

Expenditures for medical care and services administered to Medi-Cal certified eligibles can take many forms, which include capitation payments to managed care health plans, Medicare premiums for low-income dual eligibles, and federal disproportionate share hospital (DSH) payments to safety-net public hospitals.

A significant proportion of total Medi-Cal expenditures is generated through the Fee-for-Service (FFS) health care delivery system. FFS providers render services and then submit claims for payment that are adjudicated, processed, and paid (or denied) by the Medi-Cal program’s fiscal intermediary. The electronic claims records generated by these transactions provide a rich source of data that can be used to analyze the relative cost of different groups within the Medi-Cal population, and/or the cost of different services provided to Medi-Cal certified eligibles.

FFS Medi-Cal Expenditures for Treatment of HIV/AIDS

This report was developed at the request of the HIV Care Branch within the California Department of Public Health, Office of AIDS, to assist counties with budget estimates and the annual Ryan White Part A grant application for the federally defined Eligible Metropolitan Areas (EMAs) in California.

This report does not cover Medi-Cal managed care capitation payments or services provided through the managed care delivery
system. This report replaces the former Semi-Annual AIDS-Related Expenditure Report, which was developed at the direction of CMS Region IX. The report discloses unduplicated user counts and expenditures by EMA, County, and Type of Service for individuals who have been treated for HIV/AIDS. As noted above, services provided through FFS Medi-Cal include services to individuals enrolled in Medi-Cal managed care plans if those services have been excluded from Medi-Cal managed care contracts.

Medi-Cal Funded Induced Abortions

This report presents statistics on induced abortions during each Calendar Year (CY). Federal funding is generally not available for these services; therefore, induced abortions are financed with state funds only. Summary data are provided for health care delivery system, race/ethnicity, age group, and aid category. The number of induced abortions and expenditures by procedure type and county are also provided for the Fee-for-Service (FFS) delivery system. Managed care plans are paid on a capitated basis; therefore, detailed expenditures are not available.

Medi-Cal Funded Abortions - CY 2014
Medi-Cal Funded Abortions - CY 2013

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Last modified date: 4/16/2024 11:30 AM

​​Medi-Cal and Fee-For-Service Expenditures

FFS Medi-Cal Expenditures for Treatment of HIV/AIDS

Medi-Cal Funded Induced Abortions

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Medi-Cal and Fee-For-Service Expenditures