2010 Edition — California’s Health Care Safety Net

Facts and figures

Trisha McMahon, Blue Sky Consulting Group
Matthew Newman, Blue Sky Consulting Group


The health care safety net is a term that describes the intersection of three loosely coordinated, continuously evolving components: public health care programs, health care providers, and the population of low-income uninsured with unmet medical needs. for this presentation, the safety net population is defined as Californians with incomes below 300 percent of the federal poverty level (FPL). The nature and scope of the safety net changes constantly in response to the level of need, the economy, and shifts in policy and budget priorities.

The Affordable Care Act of 2010 promises to again reshape the health care safety net, dramatically expanding both Medicaid and private insurance coverage. implementation of health care reform will bring financial relief to the health care safety net as well as changes in the populations served. This chart book provides a snapshot of California’s health care safety net on the eve of what will likely be a decade of fundamental transformation.

Key findings include:

  • 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 health care program. Among this group, 37 percent were uninsured and 53 percent were enrolled in Medi-Cal. Ten percent  were enrolled in Healthy families or another 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 percent of inpatient and 82 percent of outpatient hospital care under Medi-Cal, as well as 73 percent of inpatient and 96 percent 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.
  • Seventy-eight percent of primary care community clinics visits in 2008 were made by safety-net patients; 56 percent were by people enrolled in Medi-Cal or Healthy families, and 22 percent by the uninsured or indigent.
  • Safety-net providers rely on Medi-Cal funding. Seventy-three percent of community clinic net revenue is paid by the program; among public hospitals the proportion is 63 percent. Fourteen percent of nonprofit hospital net revenue is paid by Medi-Cal.
  • Other sources of public funds are important as well; 22 percent of public hospital total revenue is from county contributions, while 28 percent of community clinic revenue is from government grants.
  • In general, the safety-net population receives less in the way of health care services than the non-safety-net population (those with incomes above 300 percent 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 for download below. This material is part of CHCF’s California Health Care Almanac, an online clearinghouse for key data and analyses describing the state’s health care landscape. See our entire collection of current and past editions of California’s Health Care Safety Net.