California has faced record-setting wildfire seasons over the past few years that have caused traumatic evacuations, destruction of property and loss of lives, and smoke with far-reaching health impacts. Prescribed burning, or intentionally setting fire to the land, is one option to mitigate extreme fire outcomes. However, prescribed burning also generates smoke emissions and resultant health damages; these emissions are subject to air quality regulations not faced by wildfire smoke. This study employs a modeling framework to evaluate the costs and benefits of significantly scaling up prescribed burning in California. The framework includes three steps: projecting wildfire and prescribed fire over the next several decades, estimating emissions from both wildland and prescribed fire, and modeling the cost of health damages due to emissions. To project wildfire, we initialize a model with historic fire data and existing fire risk maps, then run it forward in time with stochastic outcomes conditioned on a given location’s fire history. We then run this model statewide thousands of times to predict the mean effect and uncertainty of various wildfire and prescribed fire scenarios on total fire outcomes. We find that the location, timing, and intensity of emissions differs in scenarios with prescribed burning, resulting in different health outcomes. Furthermore, the benefits of prescribed fire are more pronounced under higher wildfire projections. This work has important implications for policies regarding the future impact of wildfires and for the expanded use of prescribed fire as a possible mitigation strategy.