The County Medical Services Program (CMSP) was established in 1983, when California law eliminated low-income adults from Medi-Cal and transferred responsibility for their health care to California counties. This law recognized that many smaller, rural counties were not in the position to assume this new responsibility, and provided counties with a population of 300,000 or fewer with the option of contracting back with the State to provide these health care services through CMSP. The State Department of Health Services (DHS) utilized the administrative infrastructure of Medi-Cal’s fee-for-service program to administer CMSP.
From 1983 to 1992 the State retained financial responsibility for CMSP. Following State/Local Program Realignment in 1991, a state-county partnership was established that dedicated specific revenues (motor vehicle license fees and sales tax) to support indigent health care at the county level.Realignment revenue then became the primary revenue source supporting CMSP. In 2013, in anticipation of the Affordable Care Act (ACA) and the expansion of Medi-Cal to cover low-income uninsured adults, realignment was substantially revised and most revenue previously dedicated to indigent health care was redirected to the State of California. Counties participating in CMSP retained only a portion of the revenue for continued provision of health care services to the remaining uninsured left uncovered by the ACA.