California ranks last overall due to weak performance across nearly every major scoring category, including Medicaid expansion, rapid spending growth, high per-enrollee cost growth, weak private coverage retention, and high improper payment rates. The state also performs poorly on early work requirement activity, provider flexibility, and interstate licensure participation. California’s strongest areas are APCD activity, MCO presence, and the absence of CON laws.
Strengths
MCO presence
Existing APCD infrastructure
No active CON laws
Relatively low Medicaid share of the state budget
Weaknesses
Medicaid expansion
No early work requirement activity
High spending and per-enrollee cost growth
Weak provider flexibility and low primary care provider supply
