THE PATTERN RECOGNITION IS PUBLIC
Dispatches from California’s Medicaid transformation
The work is moving fast, and the useful lessons are not always in the slide decks.
Jim Hickman, Founder & Chief Catalyzer of Hickman Strategies, tracks what is happening on the ground: inside provider convenings, PATH/CPI collaboratives, managed care conversations, rural health work, and the operational decisions that determine whether policy reaches people.
PUBLISHED IN HEALTH AFFAIRS
The Equity Cliff: Federal Medicaid Cuts Are About To Undo California's Health System Gains
Health Affairs | July 29, 2026
Jim Hickman, Abner Mason, and Jeremy Cantor
Three years into CalAIM, the results are real. Nearly 453,000 Medi-Cal members reached through Enhanced Care Management, more than 528,000 through Community Supports, in the communities the health system has failed longest. The question in front of us is not whether that progress happened. It is whether it survives December 31, 2026.
The decline has already started. Medi-Cal enrollment fell by roughly 730,000 people between June 2025 and March 2026, more than half of that in the first quarter alone, and all of it before the major provisions of H.R. 1 take effect.
Abner Mason, Jeremy Cantor and I wrote this because everything California needs to hold its gains already exists, except time. We name three choices in the piece. The next six months are when they get made, and the partners who can make them are already in the room.
Jim Hickman, Abner Mason, and Jeremy Cantor, "The Equity Cliff: Federal Medicaid Cuts Are About To Undo California's Health System Gains," Health Affairs Forefront, July 29, 2026. https://www.healthaffairs.org/content/forefront/equity-cliff-federal-medicaid-cuts-undo-california-s-health-system-gains
DOI: 10.1377/forefront.20260722.557389 Copyright © 2026 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.
FEATURED FIELD NOTES
The Orchestrator County
SE-06 | February 26, 2026
California’s Medicaid transformation is facing its most consequential stress test since ACA expansion. The infrastructure to answer it already exists. Here is what it looks like.
The Commission Keeps Describing a Gap No One Has Funded
No. 20 | July 27, 2026, 2026
Notes from Meeting #4 of the Future of Medi-Cal Commission, and the comment I put in front of the work groups
Back to basics. ECM, refined not retired.
No. 18 | May 21, 2026
What the January 1, 2027 refinement asks of the counties, CBOs, and plans that built the program well.
$50 Billion for Rural Health: What It Means for CalAIM
SE-02 | december 30, 2025
CMS just funded the rural version of what California has been building for three years.
STAY CLOSE TO THE WORK
Follow the practical side of California’s Medicaid transformation: what is changing, what teams are learning, and what those lessons mean for the work ahead.
Field Notes is written for people inside the work: plans, counties, provider organizations, CBOs, startups, funders, and civic partners trying to make complex systems function.