2013 Edition — California’s Health Care Safety Net

A complex web

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


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The health care safety net is a patchwork of programs and providers that serve low-income Californians without private health insurance. Changes in the economy, government budgets, and health care policy can influence how the safety-net population obtains medical care.

This report provides a snapshot of California’s safety net at a critical juncture ahead of the full implementation of the federal Affordable Care Act (ACA) in 2014. Stakeholders are preparing for important ACA deadlines, such as the expansion of Medi-Cal, the state’s largest safety-net program, while legal and political battles wage on over the future of health care reform.

California’s Health Care Safety Net: A Complex Web reflects a time of economic dislocation (much of the data for this report comes from 2009, the most recent year for which data are available). California unemployment reached 12% by the end of 2009, and monthly Medi-Cal enrollment peaked at over 7 million Californians that year. at the same time, the state trimmed billions of dollars from its budget by eliminating certain Medi-Cal services for adults, freezing Healthy families enrollment for children, and cutting funding to community clinics. one bright spot was the american recovery and reinvestment act (arra) of 2009, which provided stimulus funds to hospitals, clinics, and Medi-Cal.

Key findings include:

  • In 2009, 3 in 10 Californians could be counted in the health care safety-net population because they were low-income and either enrolled in public programs or uninsured. adults represented the largest portion of this population (59%).
  • In 2010, 68% of net patient revenue for public hospitals came from Medi-Cal and county indigent programs, compared to 17% for private nonprofit hospitals. in addition, public hospitals relied on county financial contributions, which decreased 6% since 2008.
  • The safety-net population accounted for 79% of community clinic visits. Most of the funding for this care came from Medi-Cal, which funded 57% of community clinic visits but provided 71% of the clinics’ net patient revenue.
  • Compared to the non-safety-net population, Californians in the safety net were less likely 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 (3.2%) as a percentage of income than the non-safety-net population (1.7%). In addition, third-party payers spent one-third less on their behalf.

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.