The health care safety net describes the intersection of three loosely coordinated, continuously evolving components: public health care programs, health care providers, and the low-income, uninsured population with unmet medical needs. The nature and scope of the safety net changes constantly due to many factors, including population needs, the economy, and shifts in policy and budget priorities.

Implementation of federal health reform promises to again reshape the health care safety net, dramatically expanding both Medicaid and private insurance coverage. With the prospect of financial relief to the health care safety net as well as changes in the populations served, this California Health Care Almanac report provides a snapshot on the eve of what will likely be a decade of fundamental transformation.

For this presentation, the safety-net population is defined as Californians with incomes below 300% of the federal poverty level (FPL).

Among the key findings:

• The health care safety net is composed of numerous programs that vary widely in their eligibility criteria and services covered.
• As recently as 2007, three out of ten Californians were in the safety-net population — either uninsured or enrolled in a public program. Of these, 37% were uninsured and 53% enrolled in Medi-Cal. Another 10% were enrolled in Healthy Families or other public program. Given that these data predate the economic recession, the numbers have certainly increased.
• The largest safety-net providers are public hospitals and private nonprofit hospitals, which together provide 70% of inpatient and 82% of outpatient hospital care under Medi-Cal, as well as 73% of inpatient and 96% of outpatient county indigent hospital care. Private nonprofit hospitals provide most of the Medi-Cal care, while public hospitals provide most of the county indigent care.
• In 2008, 78% of primary care visits at community clinics were made by safety-net patients: 56% by people enrolled in Medi-Cal or Healthy Families, and 22% by the uninsured or indigent.
• Safety-net providers rely on Medi-Cal funding: 73% of community clinic net revenue is paid by the program. The proportion for public hospitals is 63%; 14% of nonprofit hospital net revenue is paid by Medi-Cal.
• Other sources of public funds are important as well: 22% of public hospital total revenue is from county contributions while 28% of community clinic revenue is from government grants.
• In general, the safety-net patient population receives less in the way of health care services than the non-safety-net population (those with incomes above 300% of FPL or the insured). The safety-net population is more likely to lack a usual source of care, to delay needed care, and to be hospitalized for an avoidable cause.

The full report is available as a Document Download.