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California's Health Care Safety Net: A Sector in Transition

Katrina Connolly and Matthew Newman, Blue Sky Consulting Group

The health care safety net comprises a patchwork of programs and providers that serve low-income Californians. How have policy changes affected their services?

Economic conditions, fluctuating government budgets, and policy changes can affect those who rely on safety-net programs and providers for medical care.

California's Health Care Safety Net: A Sector in Transition covers a period of significant change, with the 2014 implementation of the federal Patient Protection and Affordable Care Act (ACA), which expanded Medi-Cal eligibility to most adults with incomes up to 138% of the federal poverty level (FPL) and established state health care exchanges that enabled individuals to purchase insurance, often with federal subsidies.

Key findings include:

  • In 2014, 3 in 10 Californians could be considered part of the safety-net population because they were low-income and enrolled in public programs or were uninsured.
  • While public and private nonprofit hospitals provide the most safety-net care, public hospitals are much more reliant on safety-net funding sources to finance their operations. In 2014, 70% of public hospital net patient revenue came from Medi-Cal and county indigent programs, while only 19% of private nonprofit hospital revenue did.
  • The safety-net population accounted for 83% of community clinic visits. Most of the funding for this care came from Medi-Cal, which funded 68% of community clinic visits, and provided 79% of the clinics' net patient revenue.
  • While insurance coverage of the safety-net population increased from 21% to 24% from 2013 to 2014, access to care may continue to be a problem. Those who access safety-net providers reported more difficulty finding providers who accepted new patients or their insurance relative to the non-safety-net population.
  • Californians in the safety net were less likely than those outside the safety net to have a usual source of care, less likely to access preventive care, and more likely to delay care.
  • The safety-net population spent more money out-of-pocket for health care as a percentage of income (3.1%) than the non-safety-net population (1.6%). In addition, third-party payer spending for the safety-net population was one-third of the amount spent on the non-safety-net population.

The full report, all the charts found in the report, as well as previous versions, is available as a Document Download.

Infographic - California's Safety-Net Population: Those with Less Spend More and Get Less

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The CHCF Almanac regularly publishes data and analysis on California's health care market.

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