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Medi-Cal Managed Care Capitation Rates by Managed Care Plan Models
The datasets contain reimbursement rates paid to participating County Organized Health Systems, Geographic Managed Care, Regional, Senior Care Act (SCAN), Single Plan, and Two-Plan model counties as well as Program of All-Inclusive Care for the Elderly (PACE) organizations for calendar years 2021-2025.
Complete Metadata
| @type | dcat:Dataset |
|---|---|
| accessLevel | public |
| contactPoint |
{
"fn": "Capitated Rates Development Division",
"@type": "vcard:Contact",
"hasEmail": "mailto:opendata@dhcs.ca.gov"
}
|
| description | The datasets contain reimbursement rates paid to participating County Organized Health Systems, Geographic Managed Care, Regional, Senior Care Act (SCAN), Single Plan, and Two-Plan model counties as well as Program of All-Inclusive Care for the Elderly (PACE) organizations for calendar years 2021-2025. |
| distribution |
[
{
"@type": "dcat:Distribution",
"title": "Two-Plan Model",
"format": "CSV",
"mediaType": "text/csv",
"describedBy": "https://data.ca.gov/api/action/datastore_search?resource_id=3739ccc8-9003-419d-b4c9-0fd0abe0d448&limit=0",
"description": "This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans in Two-Plan model counties from 2021-2024 Calendar Year. In Two-Plan model counties, the Department of Health Care Services (DHCS) contracts with a local initiative (county organized) and a commercial plan.
__See Calendar Year tabs for changes throughout the years.__
__For archived data, please refer to the historical landing page at [Medi-Cal Managed Care Capitation Rates – Two-Plan Model](https://data.chhs.ca.gov/dataset/medi-cal-managed-care-capitation-rates-two-plan-model)__",
"downloadURL": "https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/833ddd94-d5ea-4bbc-8980-ba236ab64bf8/download/two-plan-model-2025.csv",
"describedByType": "application/json"
},
{
"@type": "dcat:Distribution",
"title": "Single Plan Model",
"format": "CSV",
"mediaType": "text/csv",
"describedBy": "https://data.ca.gov/api/action/datastore_search?resource_id=5d70e73a-1dca-4d0e-b1c7-f55d3ef364a1&limit=0",
"description": "Medi-Cal Managed Care Capitation Rates for the single plan models for Calendar Year 2024. DHCS contracts with an MCP that operates under the authorization and sponsorship of a county or local authority.
__See Calendar Year tabs for changes throughout the years.__",
"downloadURL": "https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/1d96751e-59c3-4cd2-9c75-32a6e777ba4b/download/single-plan-2025.csv",
"describedByType": "application/json"
},
{
"@type": "dcat:Distribution",
"title": "Senior Care Action Network (SCAN)",
"format": "CSV",
"mediaType": "text/csv",
"describedBy": "https://data.ca.gov/api/action/datastore_search?resource_id=702ef60f-777c-42aa-a56d-bab83283f653&limit=0",
"description": "Medi-Cal Managed Care Capitation Rates for Capitated Rates for Senior Care Action Network (SCAN) – for Calendar Year (CY) 2021-2025. Senior Care Action Network (SCAN) Health Plan is a Medicare Advantage Special Needs Plan that contracts with the Department of Health Care Services for dual eligible Medicare/Medi-Cal population subset residing in Los Angeles, San Bernardino, and Riverside counties.
__See Calendar Year tabs for changes throughout the years.__
__For archived data, please refer to the historical landing page at [Medi-Cal Managed Care Capitation Rates - Senior Care Action Network (SCAN)](https://data.chhs.ca.gov/dataset/medi-cal-managed-care-capitation-rates-senior-care-action-network-scan)__",
"downloadURL": "https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/e9e46e92-b9cd-4cef-bd0f-13448e3e6a9a/download/senior-care-action-network-scan-2025.csv",
"describedByType": "application/json"
},
{
"@type": "dcat:Distribution",
"title": "Geographic Managed Care (GMC)",
"format": "CSV",
"mediaType": "text/csv",
"describedBy": "https://data.ca.gov/api/action/datastore_search?resource_id=78660036-3a7e-49e0-a23f-ce49ac75b82d&limit=0",
"description": "Medi-Cal Managed Care Capitation Rates – Geographic Managed Care (GMC) for Calendar Years 2021-2024. Medi- Cal managed care health plans in the Sacramento and San Diego counties.
__See Calendar Year tabs for changes throughout the years.__
__For archived data, please refer to the historical landing page at [Medi-Cal Managed Care Capitation Rates - Geographic Managed Care (GMC)](https://data.chhs.ca.gov/dataset/medi-cal-managed-care-capitation-rates-geographic-managed-care-gmc)__",
"downloadURL": "https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/7d140e72-4dc6-4c5f-88b2-22e96a9876e1/download/geographic-managed-care-gmc-2025.csv",
"describedByType": "application/json"
},
{
"@type": "dcat:Distribution",
"title": "Program of All-Inclusive Care for the Elderly (PACE) Rates",
"format": "CSV",
"mediaType": "text/csv",
"describedBy": "https://data.ca.gov/api/action/datastore_search?resource_id=a7836ce8-5037-4289-9fd5-5e0b17428b3e&limit=0",
"description": "The dataset contains reimbursement rates paid to participating Program of All-Inclusive Care for the Elderly (PACE) organizations for calendar years 2021-2024. To be eligible for the PACE program, a person must be 55 years of age or older and reside in one of the following PACE service areas: Alameda, Contra Costa, Fresno, Humboldt, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, Santa Clara, Stanislaus.
__See Calendar Year tabs for changes throughout the years.__
__For archived data, please refer to the historical landing page at [Program of All-Inclusive Care for the Elderly (PACE) Rates](https://data.chhs.ca.gov/dataset/program-of-all-inclusive-care-for-the-elderly-pace-rates)__",
"downloadURL": "https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/e2af0f7c-2b53-46a5-8bf0-601e2e51f3d1/download/program-of-all-inclusive-care-for-the-elderly-pace-rates_2021-2025.csv",
"describedByType": "application/json"
},
{
"@type": "dcat:Distribution",
"title": "Regional Model/Rural Expansion",
"format": "CSV",
"mediaType": "text/csv",
"describedBy": "https://data.ca.gov/api/action/datastore_search?resource_id=b156eed2-7938-40f1-926c-19a6394a495e&limit=0",
"description": "This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans in the Regional model, for Calendar Years 2021-2024. The Regional Model serves beneficiaries in 28 rural counties: Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Inyo, Imperial, Lake, Lassen, Mariposa, Mendocino, Modoc, Mono, Nevada, Placer, Plumas, San Benito, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, and Yuba. The Department of Health Care Services (DHCS) contracts with two Commercial plans to provide services in each county. San Benito is the only exception where beneficiaries can choose either the managed care plan or (fee-for-service) Medi-Cal.
__See Calendar Year tabs for changes throughout the years.__
__For archived data, please refer to the historical landing page at [Medi-Cal Managed Care Capitation Rates – Regional Model/Rural Expansion](https://data.chhs.ca.gov/dataset/medi-cal-managed-care-capitation-rates-regional-model-rural-expansion)__",
"downloadURL": "https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/d55907d0-ffbe-4817-9d08-74ff2c85e74a/download/regional-model-2025.csv",
"describedByType": "application/json"
},
{
"@type": "dcat:Distribution",
"title": "County Organized Health Systems (COHS) Model",
"format": "CSV",
"mediaType": "text/csv",
"describedBy": "https://data.ca.gov/api/action/datastore_search?resource_id=e1cd0176-8832-4d40-b531-df51fb4a08f6&limit=0",
"description": "This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans in the COHS model for Calendar Years 2021-2025. The COHS serves beneficiaries in 22 counties. In the COHS model counties, the Department of Health Care Services (DHCS) contracts with a health plan created by the county Board of Supervisors. In a COHS county, all Medi-Cal members are enrolled in the same managed care health plan.
__See Calendar Year (CY) tabs for changes throughout the years.__
__For archived data, please refer to the historical landing page at [Medi-Cal Managed Care Capitation Rates – County Organized Health Systems (COHS) Model](https://data.chhs.ca.gov/dataset/medi-cal-managed-care-capitation-rates-county-organized-health-systems-cohs-model)__",
"downloadURL": "https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/b053161a-8155-43e5-98ab-11274ecd9cda/download/county-organized-health-systems-cohs-model-2025.csv",
"describedByType": "application/json"
},
{
"@type": "dcat:Distribution",
"title": "Data Dictionary - Two-Plan Model",
"format": "CSV",
"mediaType": "text/csv",
"description": "Data Dictionary for https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/833ddd94-d5ea-4bbc-8980-ba236ab64bf8/download/two-plan-model-2025.csv",
"downloadURL": "https://data.ca.gov/datastore/dictionary_download/3739ccc8-9003-419d-b4c9-0fd0abe0d448",
"isDataDictionary": true
},
{
"@type": "dcat:Distribution",
"title": "Data Dictionary - County Organized Health Systems (COHS) Model",
"format": "CSV",
"mediaType": "text/csv",
"description": "Data Dictionary for https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/b053161a-8155-43e5-98ab-11274ecd9cda/download/county-organized-health-systems-cohs-model-2025.csv",
"downloadURL": "https://data.ca.gov/datastore/dictionary_download/e1cd0176-8832-4d40-b531-df51fb4a08f6",
"isDataDictionary": true
},
{
"@type": "dcat:Distribution",
"title": "Data Dictionary - Senior Care Action Network (SCAN)",
"format": "CSV",
"mediaType": "text/csv",
"description": "Data Dictionary for https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/e9e46e92-b9cd-4cef-bd0f-13448e3e6a9a/download/senior-care-action-network-scan-2025.csv",
"downloadURL": "https://data.ca.gov/datastore/dictionary_download/702ef60f-777c-42aa-a56d-bab83283f653",
"isDataDictionary": true
},
{
"@type": "dcat:Distribution",
"title": "Medi-Cal Managed Care Capitation Rates - Read Me",
"format": "md",
"mediaType": "application/octet-stream",
"description": "This is the methodology of each model by year of managed care rate changes.",
"downloadURL": "https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/2950026a-b62e-4048-9758-3aa97a89ab13/download/capitation_rates_by_model_read_me.md"
},
{
"@type": "dcat:Distribution",
"title": "All resource data",
"format": "ZIP",
"mediaType": "application/zip",
"downloadURL": "https://data.chhs.ca.gov/dataset/4f2af880-e909-466a-bb2d-9fd010fa0e69/resource/eed20b52-3f1d-450a-9ee1-7ff2208fae61/download/medi-cal-managed-care-capitation-rates-by-managed-care-plan-models-consolidated-b2ydmtpq.zip"
}
]
|
| identifier | cc080c9a-8ad4-4deb-8d41-db96481ffd86 |
| issued | 2025-09-02T18:50:39.444342 |
| keyword |
[
"COHS",
"Capitation Rates",
"DHCS",
"GMC Rates",
"Managed Care",
"PACE Rates",
"Plan Models",
"Regional Model Rates",
"SCAN",
"Single Plan",
"Two-Plan Rates",
"california department of health care services"
]
|
| license | http://www.opendefinition.org/licenses/cc-by |
| modified | 2025-12-22T23:15:33.244396 |
| publisher |
{
"name": "California Department of Health Care Services",
"@type": "org:Organization"
}
|
| theme |
[
"Health and Human Services"
]
|
| title | Medi-Cal Managed Care Capitation Rates by Managed Care Plan Models |
