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Locally Sourced: The Crucial Role of Counties in the Health of Californians

Deborah Reidy Kelch

A lot of health care happens in our own backyards. This report looks at the role of California's counties in providing health services for our state's most vulnerable residents.

For decades, California's 58 counties have been core providers of health care services and public health programs in local communities. Under state law, counties are the primary providers of health care for low-income people who have no other form of health coverage. Counties organize and oversee local mental health and substance use disorder programs, primarily for Medi-Cal and uninsured patients. County public health departments operate public health laboratories and administer a range of disease prevention and health promotion programs.

To administer and support this wide array of health programs and services, counties must navigate a complex set of federal, state, and local funding streams and requirements. One significant, complicating aspect of the state-county partnership on health has been a back-and-forth shift in responsibility for program administration, funding, and decisionmaking between the state and counties.

With the unprecedented changes in health care delivery following passage of the Affordable Care Act (ACA), county health programs are in a period of flux as new state and federal policies are implemented, revised, and reframed. In the coming years, the role of counties in providing health care and public health programs will continue to evolve as public and private health care markets mature under the ACA's framework of expanded health coverage and delivery system reform. Even in a changed health care environment, counties will continue to be core providers of health care and public health services for Californians.

This report, an update of the 2011 edition, describes the following:

  • County health services and programs for medical care, behavioral health, and public health
  • Core health responsibilities that counties assume and the arrangements counties use to meet those responsibilities
  • State and federal policies affecting county programs, including some that are pending or in process

The full report, as well as the previous report from 2011, is available under Document Downloads.

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