Since 1997, federal policy has made it possible to draw down federal Medicaid reimbursement for off-site inpatient health care services for eligible state prison inmates. Most recently, the Patient Protection and Affordable Care Act and the associated Low-Income Health Program (LIHP) created as part of the state's "Bridge to Reform Waiver" have expanded the number of inmates eligible for the state's Medicaid program (known as Medi-Cal) and have increased the total amount of reimbursements the state can receive. Our research finds that while the state has recently developed a process for obtaining federal funds for such services, the state has been unable to maximize the available federal funding. In particular, the federal court-appointed Receiver overseeing prison medical care has been unable to secure memoranda of understanding (MOUs) with certain counties to enroll inmates in their LIHPs. In addition, the Department of Health Care Services (DHCS) has been unable to process certain claims for federal reimbursement because of technical and quality control problems. In order to ensure that the state maximizes the available federal funding, we recommend that the Legislature (1) hold budget hearings to identify and resolve any remaining obstacles preventing the Receiver from securing MOUs with counties to enroll inmates in their LIHPs, and (2) require DHCS to report on its efforts to address problems that are preventing certain claims for federal reimbursement from being successfully processed.