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Medi-Cal, our state’s Medicaid program, is the cornerstone of California’s health care system. Funded with both state and federal dollars, Medi-Cal provides health care services to more than 13 million low-income Californians, including children, working parents, seniors, and others. Enrollment in Medi-Cal increased by several million after state policymakers fully implemented the federal Affordable Care Act (ACA) in 2014, in part by expanding coverage to low-income parents and other adults who previously were ineligible. Medi-Cal enrollees live in all 58 California counties and comprise more than one-quarter of the population in 49 counties. Of the 10 counties with the highest shares of residents enrolled in Medi-Cal, six are in the San Joaquin Valley: Tulare (55.0%), Merced (51.5%), Fresno (49.9%), Madera (45.3%), Kern (45.1%), and Stanislaus (44.5%). However, millions of Californians are at risk of losing Medi-Cal coverage if President-elect Trump and the Republican-led Congress enact, as expected, proposals to repeal the ACA and cut annual federal funding for Medicaid.