County Health Care Access for Uninsured Californians

This is a resource for uninsured Californians and those that assist them in enrollment to learn about county indigent programs and their eligibility requirements. (Detailed PDF)

Most Californians get coverage through employers, through state and federal public programs like Medicare or Medicaid (Medi-Cal in California), or by buying a health plan with affordability assistance through Covered California. While California has taken aggressive steps to implement and improve on the Affordable Care Act, including by expanding Medi-Cal to all who are income eligible, regardless of family composition, age, or immigration status, some Californians above that poverty-level income might fall through gaps in state coverage options, due to affordability or administrative burden, or missing open enrollment periods for Covered California or employer-based coverage. For those uninsured Californians, there may be county-level options to get the care they need.

Background on County Health Care Programs: 

California counties are required by California Welfare and Institutions Code 17000 to provide care of last resort to low-income uninsured “medically indigent” residents who have no other options. However, counties vary widely on what they do, how they do it, and who they serve. The code does not define any specific eligibility requirements, allowing counties to create and implement their own programs, including differing coverage based on income and immigration status. Unfortunately, this results in a patchwork of coverage that varies county by county, where the level of an uninsured person’s health care coverage may depend on where they reside. 

  • Twelve counties run public hospitals or hospital systems and clinics that have a focus on serving uninsured and Medi-Cal patients; some others fund community clinics, and yet others contract with private providers. 
  • Some counties have medically indigent care programs, providing residents who sign up with a medical home. While these are generally much more limited than a traditional health plan in benefits and network (for example, it would not provide any care outside the county), these programs offer a regular source of primary and preventive care, and sometimes connections to specialists and hospital care. 
  • Counties place differing limits on age, income, and immigration status for such programs.  

Undocumented people have been historically one of the biggest groups excluded from state and federal coverage options, but California has taken steps in the last decade to undo those barriers, with expansion to children, then young adults aged 19–26, then older adults 50 and over, and finally, people aged 26–49 in 2024. Yet with Medi-Cal eligibility limited to people under 138% of the Federal Poverty Level—currently $20,783 for one person and $43,056 for a family of four—over a half-million Californians are not eligible for Medi-Cal, and yet excluded from Covered California due to immigration status. 

While county programs once served tens or even hundreds of thousands of Californians, many of those enrollees are now covered by Medi-Cal through the Affordable Care Act and more recent expansions. This provides the opportunity for counties to focus their indigent care programs on the remaining uninsured, who are lower income but just above the poverty threshold, and in some cases undocumented.  

  • During the implementation of the Affordable Care Act and the Medicaid expansion, over 36 counties created or expanded their indigent care programs to cover the undocumented as a major percentage of the remaining uninsured. 
  • During the last year with the expansion of Medi-Cal regardless of immigration status, some counties like Contra Costa and the County Medical Services Program that serves many small and rural counties, raised their income eligibility to 300% of the poverty level to better serve the remaining uninsured. 

The following is a list of county health care programs, many that provide primary and preventive care, and other services within county lines. The eligibility listed is a general guide, but for updated information and specific eligibility requirements, please contact your county. We hope this helps individual Californians connect with care in specific counties and helps advocates and assisters in the effort to strengthen the safety-net options for uninsured and underinsured Californians. (Updated August 2024)

Guide to County Health Care Programs for Uninsured Californians – 2022 (Detailed PDF)

County Indigent Care Report »