California's 58 counties are core providers of an array of local health services, covering care for low-income, underserved, and uninsured populations, public and environmental health, and mental health, including treatment for substance abuse. They rely on a complex and shifting patchwork of federal, state, and local funds.

County revenues to help pay for these programs are dramatically affected year to year by economic and fiscal challenges, and the policy and political landscape, at all levels of government.

Federal health reform under provisions of the Affordable Care Act (ACA) creates many new challenges and opportunities for California counties in defining and implementing their health-related programs and responsibilities. At the same time, persistent fiscal and budgetary constraints will continue to challenge county health providers to maintain core services in the face of cutbacks. Policy deliberations arising from the ACA, along with budgetary challenges, have the potential to reshape state and local relationships over the next decade. This will certainly affect public services, including health services.

The successes and failures of county health programs can have a dramatic effect on access, affordability, and availability of health services for everyone. This update of a 2004 report offers a point-in-time overview of the range of health services and programs that are now the responsibility of California counties, either by statute, by practice, or by default.

The report outlines:

• Basic responsibilities now assigned to counties in the areas of medical care services for low-income populations, public health, mental health, and treatment for substance abuse
• The funding streams for these services and programs
• The varying methods counties use to provide the services

The complete report is available as a Document Download.