There's one thing that can boost your application the most - RESEARCH - and lots of it! If you really want the best shot at staying at one of your home-state institutions, you could take a year off and do extra research. No doubt there are people out there with 225's interviewing at the same places as people with 250's/60's/70's, because they pubbed many times. I know a guy who was in the lower 230's who took a year off to do research at a competitive place and matched there when everyone else that matched there was much stronger on paper.
To get the most out of this year, you shouldn't just take one project and finish that out. You should have a few things going - case reports/series on the side, another project you can data-mine on, etc. Try to pub a few times. Start some stuff now as well.
There's a chance you just might get some Cali-love from already being there, but this is another option. Whatever you decide, best of luck.