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Report Urges Statewide Standards for Indigent Care in California

California’s safety net system varies widely from county to county and many of the three million remaining uninsured in the state still have trouble getting health care even after expanded coverage and changes from the Affordable Care Act, according to a report released yesterday.

The report from Health Access Foundation urges state policymakers to develop more statewide standards for indigent care.

“Counties have traditionally been the provider of last resort,” said Anthony Wright, executive director of Health Access California and one of the authors of the report. “And counties in California interpret their responsibility wildly and widely differently.”

Counties with broad eligibility criteria including care for the undocumented have busy safety net programs and fill a big need, Wright said, while those counties with tighter eligibility requirements have seen their indigent programs slow to almost nothing in some case.

“This spring, many counties will be making decisions about their indigent program, and we thought it would be helpful for them to see where they are in comparison to other counties,” Wright said.

The report found that:

  • Most counties in California (48 of 58 counties) offer no care to the undocumented beyond required emergency care;
  • The number of people in indigent care programs has gone down in every county in the state, due to implementation of the ACA;
  • Most counties in California (43 of the 58 counties) set eligibility for care at twice federal poverty level, with six counties setting income limits below that and nine other counties having even higher income eligibility criteria; and
  • Many counties in California are considering changing their programs to better meet community needs and the remaining uninsured, including the undocumented.

“The Affordable Care Act has relieved some pressure on the county safety net,” Wright said. “We hope this study provides a quick snapshot of what counties are doing now and what they should be doing in the future.”

A bill in the Legislature now — SB 4 by Sen. Ricardo Lara (D-Bell Gardens) — would directly address health care for the undocumented in California, but counties should be shaping their policies to help that population and the other uninsured people in the state until a statewide solution can be found, Wright said.

“Just as the Low Income Health Program was a bridge to the ACA county programs should be a bridge to a statewide solution as is being discussed this legislative session,” Wright said.

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