The spending plan takes effect today, but some Medi-Cal cuts are still pending federal approval.

Those include a series of cost-sharing measures and limits on services for Medi-Cal recipients.

Starting in October, doctors visits may be limited to seven a year, unless patients get approved for more.

Medi-Cal recipients could pay five dollar co-pays on doctors visits come November.  An emergency room visit may be 50 bucks.

Anthony Wright is from Health Access.

WRIGHT: What these cuts do is place both financial and administrative barriers for people to get the care that they need. (:06)

The state says Medi-Cal costs have been growing by six to eight percent annually. This year's cuts will yield some five percent savings.