Today, the Medi-Cal Program offers a paradox: aged and disabled beneficiaries who would benefit the most from the improved health care that can come from receiving coordinated care have largely been excluded from Medi-Cal managed care. To improve health care for this group and reduce Medi-Cal expenditures, we recommend shifting an estimated 330,000 aged or disabled persons from the fee-for-service system to Medi-Cal managed care.