Medi-Cal spending grew fastest of peers; auditors flagged billions in questionable payments

Five-second answer

True. Spending rose 77% after inflation, most among peers; auditors found $4 billion-plus questionable and 26,000 high-risk providers uninvestigated. California's total Medicaid spending grew 77% after inflation from FY2013 to FY2024, more than in Texas, Florida, New York or the nation. Over the same years the State Auditor found at least $4 billion in questionable Medi-Cal payments, kept Medi-Cal eligibility on its high-risk list, and reported in 2026 that the health department had not investigated 26,000 providers flagged as high risk. Coverage expanded sharply, and California's cost per enrollee is near the national average.

One-minute summary

The evidence

The conclusion rests on the combined record. Expand each item to see its role and limitations.

Common questions

Conclusion

Both parts of the claim hold up. MACPAC data show California's total Medicaid spending grew 77% after inflation from FY2013 to FY2024, against 55% nationally, 39% in Florida, 35% in New York and 26% in Texas. The State Auditor says Medi-Cal's budget has more than doubled in 10 years, to about $220 billion in 2026-27. Auditors repeatedly flagged weak controls. The State Auditor found in 2018 that the department paid at least $4 billion in questionable Medi-Cal payments from 2014 through 2017 because eligibility mismatches between state and county systems went unresolved, and it recommended the department resolve them and recover erroneous payments by mid-2019. The department's response is recorded as Will Not Implement. Medi-Cal eligibility has been on the auditor's high-risk list since 2007 and remained there in 2025. In October 2026 the auditor reported that the department had not researched or investigated 26,000 providers flagged as high risk for improper billing, who billed at least $12 billion in one year; it noted that not all of them may have done anything wrong and that the report was not an audit. Federal auditors separately estimated $70.9 million in payments for enrollees who had died. The other side is real. California cut its uninsured rate from 17.2% in 2013 to 6.1% in 2025, the largest drop among peers, much of the spending growth was federal ACA money, and its cost per enrollee ($8,745) is close to the U.S. average ($8,606). Large questionable-payment findings also occur elsewhere: New York's comptroller found up to $1.5 billion in improper and questionable managed-care payments. And federal officials stress that improper payments are mostly documentation problems, not proof of fraud. The fair reading is that Medi-Cal bought much broader coverage, while its oversight did not keep pace with its growth.

Related fact checks

• Related claim: California's spending per resident grew twice as fast as peers'; results didn't — California's state spending per resident grew more than twice as fast as its peers' without clearly better results.

How we checked

1. Compared total Medicaid spending growth from MACPAC data for FY2013 and FY2024 across California, Texas, Florida, New York and the U.S., adjusted with CPI-U.
2. Reviewed State Auditor reports 2018-603, 2025-601 and 2025-605, the auditor's recommendation status tracker, and HHS inspector general audits, copying key sentences verbatim.
3. Compared coverage and cost per enrollee from Census and KFF data.
4. Checked whether similar findings exist in other states.

Editorial note: Scope: Medicaid spending in California, Texas, Florida, New York and the U.S., FY2013-FY2024, and audits of Medi-Cal from 2018 to 2026. Questionable payments are not proven fraud. No external specialist review has been recorded.

Sources

Sources are labeled by kind, with what this fact check takes from each, so readers can check the evidence independently.

1. FactHub record FactHub. California vs. Texas, Florida, New York and the U.S.: spending and results, 2012-2025

   FactHub's peer-comparison dataset, including Medicaid spending growth, cost per enrollee and uninsured rates.

   • Total Medicaid spending grew 77% after inflation in California from FY2013 to FY2024, against 55% for the U.S., 39% in Florida, 35% in New York and 26% in Texas.

   • Qualifies: California's uninsured rate fell from 17.2% in 2013 to 6.1% in 2025, the largest drop among peers; its 2024 Medicaid spending per full-benefit enrollee was $8,745, against $8,606 nationally.

2. Government California State Auditor. Department of Health Care Services: Millions of Medi-Cal Beneficiaries ... (Report 2018-603, October 2018)

   State audit of Medi-Cal eligibility discrepancies.

   Reliability: Independent state auditor; it labels the payments questionable, not proven improper.

   • The department paid at least $4 billion in questionable Medi-Cal payments from 2014 through 2017 because eligibility mismatches went unresolved.

     What the source says

     Health Care Services paid at least $4 billion in questionable Medi-Cal payments from 2014 through 2017

     Summary
3. Government California State Auditor. Recommendation status, Report 2018-603

   The auditor's tracker of whether the department implemented each recommendation.

   Reliability: Statuses reflect the department's responses as assessed by the auditor.

   • The auditor recommended resolving the discrepancies and recovering erroneous payments by mid-2019; the status of that recommendation is Will Not Implement.

     What the source says

     Health Care Services should resolve the discrepancies we identified and recover erroneous payments where allowable by June 30, 2019.

     Recommendation 2 (status: Will Not Implement)
4. Government California State Auditor. State High-Risk Audit Program (Report 2025-601, Dec. 11, 2025)

   The State Auditor's high-risk list update.

   Reliability: Independent state auditor; Medi-Cal eligibility has been on the list since 2007.

   • The department has not adequately resolved Medi-Cal eligibility problems and remains on the high-risk list.

     What the source says

     Health Care Services has not adequately resolved problems involving Medi‑Cal eligibility and will remain on the state high‑risk list.

     Medi-Cal eligibility section
5. Government California State Auditor. Fraud, Waste, and Abuse Increase Medi-Cal Costs (Report 2025-605, Oct. 15, 2026)

   State Auditor report on Medi-Cal provider billing risks.

   Reliability: Not an audit and makes no recommendations; the department called it isolated anecdotes.

   • The department had not researched or investigated 26,000 providers flagged as high risk for inappropriate billing, who billed at least $12 billion in FY2024-25.

     What the source says

     has not researched or investigated 26,000 of these providers

     Key Observations

   • Medi-Cal's budget has more than doubled over the last 10 years.

     What the source says

     budget has more than doubled during the last 10 years

     Introduction

   • Qualifies: The auditor says the report is not the result of an audit.

     What the source says

     This report is not the result of an audit

     Introduction
6. Government HHS Office of Inspector General. California Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries' Deaths (A-04-18-06220, May 7, 2019)

   Federal audit of payments for deceased enrollees.

   Reliability: Federal inspector general; the figure is an estimate from a sample, and California generally agreed.

   • California made an estimated $70.9 million in unallowable payments for enrollees who had died.

     What the source says

     On the basis of our sample results, we estimated that California made unallowable payments totaling $70.9 million ($53.4 million Federal share) to MCOs during our audit period.

     Summary
7. Government Office of the New York State Comptroller. DiNapoli: Audit finds hundreds of millions of dollars in Medicaid payments went to providers not enrolled in program (June 4, 2024)

   New York comptroller's audit release.

   Reliability: New York's independently elected comptroller.

   • Qualifies: New York's comptroller found up to $1.5 billion in improper and questionable managed-care payments.

     What the source says

     found Medicaid managed care organizations made as much as $1.5 billion in improper and questionable payments to providers who did not appear to be enrolled in Medicaid.

     First paragraph
8. Government Centers for Medicare & Medicaid Services. Fiscal Year 2025 Improper Payments Fact Sheet (Jan. 15, 2026)

   Federal fact sheet on Medicaid improper payment rates.

   Reliability: Federal agency that runs Medicaid.

   • Qualifies: Improper payment measures are not measures of fraud.

     What the source says

     improper payment measurement is not a measure of fraud.

     Medicaid section
9. FactHub dataset California vs. Texas, Florida, New York and the U.S.: spending and results, 2012-2025

   Tables: peer

   Saved analysis medicaid-compare

10. FactHub chart ca-peer-medicaid-growth-chart

Update history

1. October 30, 2026 Initial version.