Abstract Increasing meteorological drought frequency and rising water demand drive groundwater exploitation beyond sustainable limits. In heavily-stressed aquifers mitigation strategies, such as Managed Aquifer Recharge (MAR), are needed to restore depleted groundwater storage. MAR is also designed to overcome short dry periods. However, wider impacts of MAR as a drought mitigation strategy remain to be quantified. The objective of this study is to assess impacts of MAR in heavily-stressed aquifers using a case study of the Central Valley in California (USA). The novelty of this study lies in its analytical approach based on long-term observational data of precipitation, groundwater levels, and MAR operations. The impact of MAR operations is assessed regionally and for different temporal scales. Results show spatially-coherent clusters of groundwater level time series in the Central Valley representing three main patterns that manifest themselves in different groundwater drought characteristics and long-term trends. The first regional pattern shows lengthened groundwater droughts and declining groundwater levels over time, indicating effects of over abstraction in aquifer sections without MAR. The second regional pattern shows reduced groundwater drought duration and magnitude related to periodically rising groundwater levels, showing short-term MAR impacts. The third regional pattern shows alleviated groundwater droughts and groundwater levels show a long-term rise, representing long-term MAR impacts. Mitigated groundwater droughts and long-term rise in groundwater levels reveal the value of long-term MAR operations and their contribution toward sustainable groundwater management. Increased institutional support is recommended to ensure longevity of MAR and thereby amplify its success as regional drought mitigation strategy in heavily-stressed aquifers.