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.
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 Data Layer Nobody Built
No. 14 | April 02, 2026
California's accountability mandates are exposing a system-wide data infrastructure gap—and healthcare transportation shows exactly where.
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.
The Number That Stayed With Me
No. 13 | March 19, 2026
Up to 50% of 2.8M Californians could lose Medi-Cal — not from ineligibility, but from paperwork.
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.