As Gavin Newsom prepares to sign his final budget as governor, I have been looking back at all of his budgets. The first post was about $370.6 billion of spending on employee compensation and benefits, which is the third largest category of state spending. The second post was about $1.005 trillion of spending on public schools, which is the second largest category of state spending. This post is about $1.18 trillion of spending on Medi-Cal, which is the largest category of state spending.
$1.18 trillion is nearly double the $620 billion of total spending on Medi-Cal during Jerry Brown’s eight years as governor from 2011-2019. On an inflation-adjusted “real” basis, total Medi-Cal spending under Newsom will be 45% greater than total Medi-Cal spending under Brown.
Another way to view the increase is to compare the baseline cost of the program from the year Brown took office to Newsom’s final budget year. In Brown’s first year (FY 2011–12), Medi-Cal spending was $45.5 Billion. In Newsom’s final year (FY 2026–27 Final Agreement), Medi-Cal spending will be $218.5 Billion. In unadjusted raw dollars, that means annual Medi-Cal spending grew by $173 billion over this 16-year timeline, a raw increase of 380%. On an inflation-adjusted basis, that is a real increase of 221%.
In other words, California’s annual Medi-Cal spending is now more than three times larger in real, inflation-adjusted size than it was when Jerry Brown took office in 2011. According to Gemini, the core difference between the two administrations is structural: Jerry Brown’s era focused on implementing federally funded expansions, while Gavin Newsom’s era focused on implementing state-funded expansions. Under Brown, the federal government picked up nearly the entire tab for new enrollees via the Affordable Care Act. Under Newsom, California took on state-funded liabilities.
