Research and Analytic Studies Division

Overview for the Medi-Cal Certified Eligibles, Summary Pivot Table Most Recent
48 Months - Updated through September 2019 Month of Eligibility

Overview
The counts reflect reported totals for the most recent 48 months through May 2019 with
four-months of reporting lag.

Pivot Table
This pivot table includes counts of Medi-Cal certified eligibles by Month, County and
Dual Eligibility.

Certified Eligible
The term Certified Eligible includes beneficiaries who have been determined eligible
for Medi-Cal based on a valid eligibility determination. Certified eligibles do not include
individuals who may be eligible to enroll in the program, or are in the process of
becoming a certified eligible, but have not enrolled. In addition, the definition used
here only includes beneficiaries who are eligible to receive Medi-Cal covered health
care services during the month. This means that beneficiaries who must meet Share
of Cost (SOC), but have not met their monthly SOC are not included in the counts.
Specific populations, such as California’s Family Planning, Access, Care and
1
Treatment (PACT) members and individuals granted temporary enrollment under the
2
Presumptive Eligibility (PE) program for pregnancy are excluded; however,
individuals granted temporary enrollment under the other PE programs, most notably,
the Hospital Presumptive Eligibility (HPE) program, are included in the certified eligible
counts.

Reporting Lag
Each month’s reported count of certified eligibles represents only a portion of that
month’s actual and final count. The most recent month’s count will generally display
the greatest discrepancy between the reported and final actual count. This is due to
various adjustments that are made retroactively to the enrollment dataset as
additional information is ascertained. Through the passage of time, the reported
count for a particular month progressively moves closer to the actual final count. A
specific month’s enrollment count is considered nearly complete six months after the
month’s end and finalized twelve months after the month’s end. Consequently,
enrollment counts for the most recent twelve months are INCOMPLETE and will
continue to be updated.

Source
The Department of Health Care Services, Management Information System/Decision
Support System (MIS-DSS) data warehouse.

Suggested Citation
State of California, Department of Health Care Services, Medical Certified Eligibles,
Summary Pivot Table by County, Most Recent 48 Months - Updated through
September 2019 Month of Eligibility, Report Date: October 2019.

Questions
Any questions regarding this file can be directed to: California Department of Health
Care Services, Research and Analytic Studies Division

For additional information on the Medi-Cal enrollment data available on this website,
please visit the Research and Analytic Studies Division page available on the
following website: Research and Analytic Studies Division

1
Annual data show that the Family PACT Program served 1.16 million clients in Fiscal
Year 2015-16. Family PACT Annual Report; FY 2015-16. URL:
http://www.familypact.org/Research/reports/Annual_Report_FY_15-16.pdf

2
The Presumptive Eligibility (PE) program provides immediate, temporary Medi-Cal
coverage for needed services to individuals deemed eligible by qualified entities.
While previously available only to low-income pregnant women and children, the PE
program in California has been expanded as of January 1, 2014 to include low-
income adults ages 19-64 and parents and caretaker relatives, as well as former
foster care children up to age 26 (no income limit).