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 had low incomes and were 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.

For more data and analysis on this topic, visit these pages from the UCLA Center for Health Policy Research, the Office of Statewide Health Planning and Development, the California Department of Health Care Services, and the Agency for Healthcare Research and Quality.

The full report, and all the charts found in the report, are available for download below. Also available is an infographic, “California’s Safety-Net Population.” These materials are 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.

About the Authors

Katrina Connolly, PhD, is a senior consultant with Blue Sky Consulting Group. Matthew Newman, MPP, is a founding partner with the Blue Sky Consulting Group.