Caring for Medically Indigent Adults in California: A History

Deborah Reidy Kelch


This is archived content; for historical reference only.

How has the evolution of public policy in California affected health care delivery and financing for medically indigent adults? This publication traces the shifting roles of the state and counties in caring for medically indigent adults from the mid-1800s to the present.

California counties are a core element of the health care safety net. They have a statutory requirement to provide health services to low-income and indigent people with no other source of care, including a population known as medically indigent adults. Local discretion to design delivery systems and funding levels has resulted in widely diverse programs among California’s 58 counties.

Examining the historical milestones that have affected county-supported services, this report highlights the link between funding and policies for public coverage programs — such as Medi-Cal — and county health care programs for the uninsured. It also highlights the complexities of the state-county fiscal relationship and the potential impact that state budget and policy decisions can have on county medical care programs.

Topics covered include:

  • The history of the legal mandate;
  • The introduction of Medicaid and the implementation of Medi-Cal;
  • Medi-Cal reform and the state’s bailout;
  • The impact of realignment; and
  • The future of county indigent health care.

The lessons of history regarding county indigent health care services can inform budget and policy decisions moving forward, and this report may serve as a valuable resource as policymakers consider ways to improve the financing and delivery of services for medically indigent adults.

The complete report is available under Document Downloads.