health care services and general assistance. county indigent medical programs can be categorized as california medical service program (cmsp) and medically indigent service program (misp) counties. there are 34 cmsp counties and 24 misp counties. the cmsp county programs are largely managed by the state, whereas misp counties manage their own programs with their own rules and regulations. many patients from both the cmsp and misp county programs transitioned to medi-cal when the patient protection and affordable care act took effect in 2014. quality of care metrics medi-cal reports quality metrics, broadly similar to the hedis metrics from the ncqa. in 2017, it reported on 13 of the 20 frequently reported from the cms medicaid/chip child core set and 15 of 19 frequently reported from the cms medicaid adult core set.