OBJECTIVES: To examine the health care utilizations and costs for patients diagnosed with congestive heart failure (CHF) in the California Medicaid (Medi-Cal) population. METHODS: A retrospective database analysis was performed using Medi-Cal claims from January 2009 through December 2014. Patients diagnosed with CHF (International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 428.x) were identified in the Medi-Cal database from 01JAN2010 through 31DEC2013. The initial diagnosis date was designated as the index date. A comparison cohort was created by identifying patients without a CHF diagnosis, but of similar age, gender, race, and index year. The index date for the comparison cohort was randomly chosen to reduce selection bias. Patients in both cohorts were required to be at least age 18 years and have continuous medical and pharmacy benefits 1-year pre- and post-index date. One-to-one propensity score matching (PSM) was performed to compare follow-up health care costs and utilizations between the cohorts, adjusting for demographic characteristics and baseline Charlson Comorbidity Index score. RESULTS: Eligible patients (N=10,790) were identified for the CHF and comparison cohorts. After 1:1 PSM, a total of 1,587 patients were matched from each cohort and baseline characteristics were balanced. A higher percentage of CHF patients had inpatient admissions (66.48% vs. 14.05%, p<0.0001), outpatient visits (98.61% vs. 75.17%, p<0.0001), and emergency room visits (66.60% vs. 27.60%, p<0.0001) compared to those without a CHF diagnosis. The CHF cohort also incurred significantly higher inpatient ($21,000 vs. $2,362, p<0.0001), outpatient ($7,595 vs. $2,362, p<0.0001), pharmacy ($3,621 vs. $1,653, p<0.0001), and total costs ($32,215 vs. $6,637, p<0.0001) than the comparison cohort. CONCLUSIONS: Results indicated that CHF patients incurred significantly higher costs and had higher health care resource utilization than those without CHF.