Health Plan Regulation

Harvest Sources

The dataset provides basic information of the FFS providers enrolled in the Medi-Cal program as of October 5, 2026. The data was retrieved from the Provider Master File (PMF), which has been used in the claims payment process and maintained by the Provider Enrollment Division (PED). The Variables in the dataset include provider number, name, type, specialty, geographic information, etc. This dataset does not include the Managed Care providers. __Note: Data may be subject to a 1-2 day lag for quality assurance.__

Updated Oct 7, 2026

Harvest Sources

This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care Health Plans by type of enrollment by reporting period. Medi-Cal Managed Care program contracts for health care services through established networks of organized systems of care emphasizing primary and preventive care. Newly eligible Medi-Cal beneficiaries must choose a Managed Care health plan within 30 days of Medi-Cal enrollment, or they will be enrolled in a Managed Care health plan by default. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.

Updated Oct 7, 2026

Harvest Sources

This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care County Organized Health System (COHS) Health Plans by reporting period. COHS is a Medi-Cal managed care health plan model that operates in 22 California counties. Each COHS is created by a county board of supervisors and governed by an independent commission. In COHS counties, a single plan serves all Medi-Cal beneficiaries enrolled in managed care. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.

Updated Oct 7, 2026

Harvest Sources

This dataset includes the number of individuals who have filed an appeal for a subsidized Covered California Qualified Health Plan (QHP), Medi-Cal, or a combination of both eligibility determinations by year and quarter. Appeals may be filed by an appellant for determinations that resulted in a denial, eligibility, or discontinuance of coverage. A denial is defined as an eligibility determination at application that resulted in a denial of coverage. An appeal regarding an eligibility determination may be filed when the appellant disputes the type of program eligibility. A discontinuance is when an individual is no longer eligible for Medi-Cal or Covered California QHP. Appeals may be filed for cases involving mixed determinations, such as when household members applied for and/or had eligibility determinations made for the two programs (i.e., parents were eligible for Covered California and the child(ren) were eligible for Medi-Cal). Covered California and Medi-Cal eligibility appeals are processed and adjudicated by Administrative Law Judges and the California Department of Social Services (CDSS) staff who track appeals and hearing results. This dataset is part of the public reporting requirements set forth in California Welfare and Institutions Code 14102.5(a)(6).

Updated Oct 7, 2026

Harvest Sources

This dataset includes the total number of newly eligible individuals by Insurance Affordability Program (IAP), by reporting period. IAPs include Medi-Cal, Covered California subsidized and unsubsidized Qualified Health Plans (QHP), and the Medi-Cal Access Program (MCAP). Covered California subsidized and unsubsidized QHP newly eligible data includes those who selected and enrolled in a QHP, and paid their first premium. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.

Updated Oct 7, 2026