New Health Access Report Details Dramatic Expansions in California’s County Health Care Safety-Net

Today, Health Access released a new report detailing the dramatic changes to California’s health care safety net programs at the county level. As the Affordable Care Act implementation has cut the number of uninsured Californians in half and the state has taken additional steps to cover all children, many California counties have extended their health care safety net programs to better serve the remaining uninsured. Counties have responded in various ways, from expanding coverage options to undocumented immigrants to providing new benefits to those already covered. A year ago, less than ten counties served undocumented Californians outside of the emergency room; on Monday, that number will expand to 47 counties.

On Monday, more Californians in 35 of the state’s most rural counties will be able to benefit from the latest expansion of the County Medical Services Program (CMSP) which includes virtually all the counties north of the Bay Area and Sacramento to the Oregon border and many in the Sierra Nevada mountains and in the Central Valley. CMSP is expanding eligibility in its main indigent care program, including raising the income level from 200% to 300% of the federal poverty level ($60,480 for a family of three). CMSP is also offering a new limited primary care benefit of three doctor visits and some pharmacy coverage to those in its program, as well as to residents (138-300% FPL) regardless of immigration status. Potentially thousands of Californians will benefit from these expansions, as well as those of other counties that have launched similar pilot programs in the last year.

Health Access’ new report, “Profiles of Progress: California Counties Taking Steps to a More Inclusive and Smarter Safety-Net,” examines the expansion in the County Medical Services Program (CMSP) along with an in-depth analyses of how six other counties adjusted their safety net programs in response to changes in need and funding. These counties include: Contra Costa, Los Angeles, Monterey, Sacramento, Santa Clara, and Fresno.

While the Affordable Care Act has gone a long way to provide new coverage options, it has been left to California and its counties to figure out how to provide care for the remaining uninsured, including those explicitly excluded from federal help due to immigration status. Taking their responsibility seriously to provide health care to the remaining uninsured, more and more California counties are thankfully taking steps to a more inclusive and smarter safety-net. This month’s expansion in 35 rural counties of primary and preventive care is another step forward to a healthier California. Thousands of Californians are benefitting from these new pilot programs, but there’s more work to do in many counties and statewide to further expand and strengthen our health system on which we all rely.

Speaking on a press conference call today were county leaders, advocates and individuals, including County Supervisors that recognized the broader benefits and policy rationale for these expansions. The report and the press conference call also highlighted the grassroots advocacy that helped bring about this rapid change.

The report predicts that additional California counties will also launch similar efforts in the near future, especially under new financial structures under both state law and the new federal Medicaid waiver and its Global Payment Program, which has incentives to offer preventive care and other treatments prior to the need for emergency or episodic care. In turn, these actions at the county level also provide additional momentum at the state level for inclusive health policies.