The County Medical Services Program (CMSP) was established in January 1983, when California law transferred responsibility for providing health care services to uninsured 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.
From 1983 to 1992 the State of California retained financial responsibility for CMSP. However, following enactment of State/Local Program Realignment in 1991, a state-county partnership was established that modified financial responsibility for the program and Health Realignment revenue (motor vehicle license fees and sales tax) became the primary revenue source supporting the program. In 2013, in anticipation of the implementation of the federal Affordable Care Act (ACA) and the expansion of Medi-Cal to cover low income uninsured adults, the provisions of Health Realignment were 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. Today, CMSP is funded exclusively by this revenue.
CMSP Program Administration
In 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 and 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 an alternative contractor to administer the program. Since October 2005, Anthem Blue Cross Life & Health Insurance Company has served as the third party administrator for CMSP.