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The state is proposing that many people enrolled in the "private option" Medicaid expansion program contribute between $5 and $25 a month. Those who don't could face additional medical expenses.
As the federal government demands more accountability, other states are working on plans to fix delays and glitches in their systems as well.
Even though the state did not expand eligibility under the health law, experts say publicity about the law spurred greater awareness of the program.
It's hard to pin down why applicants are waiting so long for approval, and when the problem will be resolved. Meanwhile, some people are putting off treatment.
The state is among the first to use financial incentives to encourage enrollees to boost their health.
Technological glitches at the federal and state levels and inadequate staffing have delayed eligibility determinations.
While a growing number of states are contracting with managed care companies to manage their Medicaid programs, there are still questions about cost savings and quality.
Critics contend the state is making it harder for people to enroll or renew their coverage.
Among those who are worried are agencies that provide adult foster care for people who can't live on their own, because of severe mental illness or developmental disabilities.
Advocates say that the option will provide more flexibility for students who are eligible for the state-federal health program for low-income people.
Many inner-city hospitals in Medicaid-expansion states report big drops in the number of uninsured people for whom they provide care.
Some embattled Democrats see Medicaid expansion as a winning issue.
California is among 25 states to open Medicaid to childless adults, including thousands of ex-offenders. Covering this group is expected to save money and perhaps reduce recidivism.
There are now three times more people with serious mental illness incarcerated in the United States than in hospitals, and the types of behavioral and mental health problems among inmates are becoming more severe.
The number of state workers needed to expand the federal-state health care program for poorer Americans is far higher than most states have needed -- typically in the dozens, not hundreds.
A survey conducted in Seattle found that half the time, primary-care providers listed as accepting new patients on Medicaid managed-care organization websites, in fact were not accepting new patients.
Despite the procedural victory, even a GOP supporter of the bill does not expect passage of the Medicaid expansion plan during this legislative session.
Hundreds of thousands of Medicaid recipients are being shifted into some kind of managed care this year as part of a sweeping overhaul.
Teresa Martinez, 62, from East Los Angeles makes $10,000 a year working as a hairdresser in a Koreatown salon. With her modest income she is likely to be eligible for health coverage under the Affordable Care Act's Medi-Cal expansion.
About 800,000 people in California are presumed to be eligible for the newly expanded program but lack final approval. For a Los Angeles hairdresser and others like her, that means medical appointments are on hold.
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