Inland Empire — Regional Market Report 2025

Introduction

The Inland Empire counties of Riverside and San Bernardino span a vast stretch of Southern California — from densely populated urban centers in the west to sparsely populated desert communities reaching the Nevada border. The region’s population continues to grow, but residents are more likely to be low income and less likely to have a college education than Californians overall. More than four in 10 Inland Empire residents rely on Medi-Cal for health coverage.

This report examines how hospitals, community health centers, physician groups, and health plans in the Inland Empire are navigating a shifting landscape of growing demand for care, workforce shortages, and looming federal and state budget cuts.

The Inland Empire is one of seven markets included in the 2025 Regional Market Reports, which focus on gaining key insights into the organization, financing, and delivery of care in communities across California and over time.

Inland Empire Health Care Market: Key Takeaways

Coverage gains have lowered the region’s uninsured rate, community health centers continue to expand, and investments in behavioral health show promise. Hospital and physician markets are relatively unconcentrated. Workforce shortages persist, and recent federal and state policy changes threaten to reverse hard-won progress on access to care.

Six Key Developments Shaping Health Care in the Inland Empire

1. Coverage Gains Have Lowered the Uninsured Rate — but It Still Exceeds the State Average

Medi-Cal eligibility expansion under the Affordable Care Act (ACA), state-funded expansion of Medi-Cal to undocumented immigrants, and increased enrollment in subsidized coverage through Covered California have significantly reduced the number of uninsured Inland Empire residents. Despite this progress, the region’s uninsured rate remains higher than the statewide average.

2. Hospital and Physician Markets Remain Relatively Unconcentrated

Unlike many California regions, the Inland Empire’s hospital and physician markets have not consolidated into a small number of dominant systems. Multiple hospital systems and independent hospitals operate across the sprawling region, and small independent physician practices continue to play a significant role. One respondent described the Inland Empire as the state’s “last frontier” for physician acquisition. However, national firms have acquired two large medical groups in recent years.

3. Community Health Centers Continue to Expand and Play a Central Role

County-based networks of Federally Qualified Health Centers (FQHCs) and other community health centers provide care to a growing share of the Inland Empire’s population. As Medi-Cal enrollment has grown, CHCs have expanded their locations and services to meet rising demand — making them essential to the region’s health care safety net.

4. Workforce Investments Are Beginning to Pay Off — but Gaps Remain

Health care workforce shortages remain widespread across the Inland Empire. However, investments in local medical schools; training programs for advanced practice providers, nurses, and technicians; and targeted recruitment and retention efforts are beginning to show results. Meeting workforce needs in the region’s remote, sparsely populated areas remains especially challenging.

5. Behavioral Health Investments and Care Integration Show Promise

Organizations across the Inland Empire have embraced state efforts to improve care coordination and connect Medi-Cal’s most vulnerable populations with behavioral health and social services. Recent investments in behavioral health infrastructure will add much-needed inpatient capacity for people with serious mental illness and substance use disorders. Still, the need — compounded by ongoing workforce shortages — continues to outpace available resources.

6. Federal and State Policy Changes Threaten Recent Gains

New state eligibility restrictions, federal administrative requirements, and federal funding cuts enacted in 2025 will decrease Medi-Cal enrollment, increase the number of uninsured residents, and reduce hospital and community health center funding across the Inland Empire. These policy shifts put both access to care and provider financial stability at risk.

Key Data on the Inland Empire

Health Insurance Coverage

Where do Inland Empire residents get their health coverage?

In 2023, four in 10 Inland Empire residents relied on Medi-Cal, and 45% had commercial insurance. The region’s uninsured rate, at over 8%, exceeds the state average of 6.4%.

Sources: MA State/County Penetration (July 2019 and July 2023), US Centers for Medicare & Medicaid Services “Selected Characteristics of Health Insurance Coverage in the United States, American Community Survey, 1-Year and 5 Year Estimates,” US Census Bureau “By Medicare Dual Status, Certified Eligibles,” California Department of Health Care Services Katherine Wilson, California Health Insurers, Enrollment Almanac — 2025 Edition, California Health Care Foundation, February 2025

Population and Economic Context

How does the Inland Empire compare to California overall?

While the overall state population failed to grow during the last five years, the Inland Empire grew by 2%. About one in four of the region’s residents have a college degree, compared to 37% of Californians overall.

Sources: Annual Estimates of the Resident Population for Counties in the United States: April 1, 2020 to July 1, 2024 (CO-EST2024-POP) Annual Estimates of the Resident Population for Counties in the United States: April 1, 2010 to July 1, 2019 (CO-EST2019-ANNRES-06) “American Community Survey 5-Year Estimates Subject Tables, S1901, Income in the Past 12 Months (in 2023 Inflation-Adjusted Dollars), 2023,” US Census Bureau “Current Industry Employment and Unemployment Rates for Counties,” California Employment Development Department “California Employment Development Department; and “Housing Affordability Index – Traditional – Historical Data Series (Q2 2024),” California Association of Realtors “Healthcare Payments Data Measures Data (2018–2023)” “Infant Mortality,” California Department of Public Health (CDPH) “California Overdose Surveillance Dashboard,” CDPH, last updated May 19, 2025. “American Community Survey, 2023 5-Year Estimates, S1810, Disability Characteristics,” US Census Bureau

Hospital Landscape

What are the largest hospital systems serving the Inland Empire?

The Inland Empire hospital market remains relatively unconsolidated, with almost 40 hospitals operating in the region. The largest five are listed below, which together account for around half of available beds and discharges in the region. Loma Linda University Health, an academic medical center affiliated with the Seventh-day Adventist Church, and Kaiser Permanente top the list.

Source: 2023 Pivot Table – Hospital Annual Selected File, California Health and Human Services Agency.

Community Health Centers

What are the largest community health center (CHC) systems in the Inland Empire?

Along with county-run CHCs, more than 50 other CHCs provide outpatient care, particularly in less populated areas and for people with lower incomes. DAP Health, a Palm Springs–based FQHC, accounted for the largest number of patient encounters in 2023, following its acquisition of San Diego–based Borrego Health, which declared bankruptcy in 2022 after allegations of fraud and mismanagement.

The largest non-county six CHC systems, listed below, provided over 60% of all CHC patient encounters in the region.

Source: 2023 Primary Care Clinic Annual Utilization Data (November 2024), California Health and Human Services Agency, last updated October 31, 2024.

Health Care Workforce

How does the Inland Empire compare to California?

The Inland Empire’s physician supply has grown substantially in recent years; however, with 229 physi­cians per 100,000 population, the Inland Empire still lags far behind the statewide average of 358.

Source: “2024 License Renewal Survey Data, Representing Active Licenses as of December 3, 2024,” custom data request, HCAI, received April 14, 2025.