‘Patchwork’ of Safety-Net Care in Calif. Likely To Remain Under ACA

Safety-net health care services in California are highly fragmented and likely will remain so once the Affordable Care Act is fully implemented next year, according to a new study by Health Access, Payers & Providers reports (Payers & Providers, 11/20).

Background

California has the highest number of uninsured residents in the U.S. and the seventh-highest uninsured rate, according to the U.S. Census Bureau (Health Access study, November 2013).

Health Access estimates that 3.4 million California residents still could lack health insurance by 2020 (Payers & Providers, 11/20).

Findings

California likely will "continue to have a highly variable patchwork of indigent care and safety-net programs and services," the study found, noting that "in some counties, consumers may have less access to care than before" the ACA was implemented.

Researchers found that California counties have responded "widely and wildly" to their obligation to provide care to low-income, uninsured residents. To provide such care:

• 12 counties run public hospital systems, with some accompanied by a network of county clinics;
• 12 counties contract with a private health care provider; and
• 34 smaller -- often rural -- counties belong to the County Medical Service Program consortium.

"The range of services provided by these counties varies, as does who is eligible for [no-cost] or reduced-cost help," the study states.

In addition, a majority of the counties do not offer care to immigrants without legal documentation. The only counties that offer safety-net care to all residents are:

• Alameda;
• Fresno;
• Kern;
• Los Angeles;
• Riverside;
• San Francisco;
• San Mateo;
• Santa Clara; and
• Santa Cruz.

The study also found that information on the care that counties offer to uninsured individuals often is not available on publicly accessible websites (Health Access study, November 2013).

Recommendations

Based on the findings, Health Access recommended that counties:

• Continue to enroll as many residents as possible in the Low Income Health Program before the state expands Medi-Cal on Jan. 1, 2014;
• Lift any income caps for LIHP to 133% of the federal poverty level;
• Suspend income redeterminations before the Medi-Cal transition begins;
• Keep programs for the medically indigent in place through 2014 or longer; and
• Be aggressive in setting up patient-centered medical homes for uninsured residents.

Medi-Cal is California's Medicaid program.

Reaction

Anthony Wright, executive director of Health Access, said, "It's cheaper to have access to primary, preventive care than to treat illnesses after they develop," adding," By ensuring that Californians have that access, counties can make sure that their residents are healthy and contributing economically to their communities" (Payers & Providers, 11/20).