The County Medical Services Program (CMSP) was established in January 1983, when California law transferred responsibility for providing health care services to indigent adults from the State of California to California counties. This law recognized that many smaller, rural counties were not in the position to assume this new responsibility. As a result, the law also provided counties with a population of 300,000 or fewer with the option of contracting back with the California Department of Health Services (DHS) to provide health care services to indigent adults. DHS utilized the administrative infrastructure of Medi-Cal's fee-for-service program to establish and administer the CMSP program.

CMSP Financing

From 1983 to 1992 the State of California retained financial responsibility for CMSP. However, following enactment of State/Local Program Realignment in 1991, a new state-county partnership was established that modified financial responsibility for the program. While the State DHS continued to administer CMSP, the State's General Fund contribution was capped at $20.2 million each fiscal year and Program Realignment revenue (motor vehicle license fees and sales tax) became the primary revenue source supporting the program. Other CMSP funding sources included Proposition 99 tobacco tax revenues, county participation fees and third-party reimbursements and recoveries. Beginning in 2000, the State suspended its General Fund contribution to CMSP and subsequently eliminated Proposition 99 funding for CMSP. Suspension of the State's General Fund contribution since 2000 has left financial responsibility for CMSP solely with the participating CMSP counties. Today, CMSP is funded exclusively by Realignment revenue (motor vehicle license fees and sales tax) and county general revenue.

CMSP Program Administration

In 1983, California law was enacted that established the CMSP as a program within the State Department of Health Services. In April 1995, California law was amended to establish the CMSP Governing Board. The Governing Board, composed of ten county officials and one ex-officio representative of the Secretary of the California Heath ad Human Services Agency, is authorized to set overall program and fiscal policy for the CMSP program. This law also authorized the Governing Board to contract with DHS or a alternative contractor to administer the program. Between April 1995 and September 2005, the Governing Board contracted with DHS to administer the CMSP program. Beginning October 1, 2005, Anthem Blue Cross Life & Health Insurance Company assumed administrative responsibility for CMSP.