The Crucial Role of Counties in the Health of Californians

California’s 58 counties are the backbone of local health care delivery — financing, administering, and directly providing essential services that keep communities healthy. Under state law, they’re on the front lines for residents with low incomes, including people who are uninsured. They organize mental health and substance use disorder services for Medi-Cal enrollees and uninsured patients alike. And through their public health departments, they run laboratories and lead programs that protect the health of entire populations.

Health Care and Public Health

Over the past decade, the passage of the Affordable Care Act, coverage expansions, and efforts to transform Medi-Cal (California’s Medicaid program) have continually reshaped the services and programs counties administer to their populations.

The Crucial Role of Counties in the Health Care and Public Health of Californians provides a comprehensive overview of how California’s counties manage responsibilities for delivering and paying for health services and programs. The report also highlights state and federal policies affecting counties’ roles in health care and public health delivery.

Behavioral Health

In recent years, California has made unprecedented investments in and significant program changes to mental health and substance use services — and counties are responsible for implementing many of them.

The Crucial Role of Counties in the Behavioral Health of Californians highlights county behavioral health department roles and responsibilities, funding streams, and delivery systems. The report also outlines how state and federal initiatives have impacted counties over the past decade.

A companion fact sheet, Funding Public Behavioral Health Care in California, summarizes the myriad funding sources for county behavioral health services.

The papers are available for download below.