OBJECTIVES: To evaluate coronary artery disease (CAD)-related expenses and health care utilization in the US California State Medicaid (Medi-Cal) population. METHODS: Patients diagnosed with CAD (International Classification of Disease, 9^th Revision, Clinical Modification diagnosis code 414.x) were identified using US Medi-Cal data from 01JAN2010-31DEC2013. The initial diagnosis date was designated as the index date. A control cohort that included patients without CAD of the same age, race, and gender was created. The index date for the control cohort was randomly assigned during the study period to minimize selection bias. Patients in both cohorts were required to have continuous health plan enrollment for 1-year pre- and post-index date. Propensity score matching (PSM) on baseline demographic characteristics and the Charlson Comorbidity Index (CCI) score were used to compare health care costs and utilizations during the follow-up period. RESULTS: Before 1:1 PSM, CAD patients (n=6,558) had higher CCI scores (2.91 vs. 1.29) than control patients and were more likely to have comorbidities, including myocardial infarction (7.87% vs. 0.41%), congestive heart failure (17.34% vs. 2.23%), diabetes (39.01% vs. 17.67%), hypertension (59.80% vs. 30.36%), and depression (17.44% vs. 10.75%, all p<0.0001). After 1:1 PSM on baseline demographic characteristics and CCI score, 1,928 patients, with balanced baseline characteristics, were matched from each cohort. Patients in the CAD cohort had higher proportions of inpatient stays (48.39% vs. 17.12%), and outpatient (98.91% vs. 74.74%), emergency room (ER) (53.79% vs. 28.27%), ambulatory (97.30% vs. 72.72%), and pharmacy visits (95.54% vs. 73.65%, all p<0.0001). Higher health care utilization translated to higher costs for CAD patients, including inpatient ($7,932 vs. $1,791), outpatient ($4,940 vs. $2,888), ER ($453 vs. $162), ambulatory ($4,488 vs. $2,725), pharmacy ($2,867 vs. $1,898), and total costs ($15,739 vs. $6,577, all p<0.0001). CONCLUSIONS: Patients with CAD had significantly higher health care utilization and economic burden compared to those without CAD.