CA: Insight into county indigent care programs after the ACA

Health Access released survey results detailing where the remaining uninsured exist and their relationship to county indigent care programs after the ACA.

Following their remarks at the most recent Covered California meeting, Health Access’s results paint a detailed picture of California’s remaining uninsured and ensuring financing exists for the uninsured at the county level. California’s 58 counties present unique challenges: from wild income disparities in the Bay to rural populations in Northern and eastern California.

Key Findings

  • County safety-net services continue to be wildly disparate
    California counties continue to be dramatically different in how they care for the “medically indigent,” both in terms of how they provide care, who is eligible due to income, immigration status, and other factors.
  • Some counties adjusted benefits but largely not eligibility
    While some counties adjusted benefits, counties generally did not change eligibility for their programs in the last two years, opting for a “wait and see” approach after both the ACA implementation and the state’s reallocation of some safety-net funds. Some counties and advocates are looking to refocus and reform their programs to better meet community needs.
  • Many uninsured Californians moved from county-based indigent care programs into ACA coverage
    The 2014 implementation of the Affordable Care Act significantly reduced the number of Californians on county indigent care programs, as counties successfully enrolled residents in Medi-Cal and Covered California.
  • Key counties see need for a stronger, smarter safety net
    Counties with broad eligibility requirements are seeing strong, continued need for their safety-net programs, with tens of thousands people enrolled in counties. Some are adapting and augmenting their programs to be more comprehensive, focusing on primary and preventive care.
  • Restricted county programs with few patients left need to refocus on the remaining uninsured
    Counties with restrictive eligibility requirements, especially those that exclude the undocumented, are finding few left in their indigent care programs—but not because there is not a need.

– Health Access (Source: “Reorienting the Safety Net for the Remaining Uninsured”)

Health Access includes their own recommendations on insuring (and thereby funding) care for the remaining population, taking into account President Obama’s recent immigration order and the demographics shifts that will bring.