The Affordable Care Act of 2010 calls for the mandatory expansion of Medicaid (Medi-Cal). Currently, Medi-Cal serves 7.5 million Californians at a cost of $45 billion per year. Healthcare reform expansion will allow 3.6 million additional Californians to enroll in Medi-Cal. However, such an increase in coverage is not without a price, with estimates of up to $3-4 billion per year of additional state expenditures by 2020.