This Almanac report presents data on the providers and programs that compose California’s system for providing health care to people with low incomes.

This paper is one of two cross-site analyses drawn on insights from the seven publications in the 2020 Regional Market Report series. In the post-ACA period, FQHCs have added patients and clinic sites at a rapid pace, and many health centers have increased offerings of specialty services and of care for elderly patients. This paper examines the changing FQHC landscape, focusing on emerging trends and regional differences in FQHCs across the state.

California's Federally Qualified Health Centers experienced many financial challenges as a result of the COVID-19 pandemic. This report summarizes policy options that have the potential to improve FQHC stability, address health equity, and ensure access to a broader range of services in the long term.

Over the last 20 years, the Bay Area health care market has consolidated, leaving four dominant systems — Kaiser, Sutter Health, UCSF Health, and Stanford Health Care. At the same time, smaller systems, such as John Muir Health and El Camino Health, play key roles in geographic submarkets, making them attractive partners for the larger systems seeking to expand market share.

Whether measured by revenue size, number of patients, or number of sites, the largest health centers bore the brunt of the financial losses experienced across California's health centers between April and December 2020.

The San Diego health care market has long been dominated by four health systems: Kaiser Permanente, Sharp HealthCare, Scripps Health, and University of California San Diego Health. Despite significant gains in health coverage, access to care for people with lower incomes, especially for behavioral health services, remains a challenge.

The Sacramento area — a region spanning El Dorado, Placer, Sacramento, and Yolo Counties — stands out among other inland California localities in boasting relatively high household incomes and a stable economy. Yet the region's hospital market continues to be dominated by four large health systems, a trend that likely contributes to the area’s high private health insurance premiums.

This paper identifies several key factors that enabled California’s health centers to manage the financial strain exacerbated by the COVID-19 pandemic while continuing to serve patients at a time when accessing health care involved new and unanticipated challenges.

This paper examines the choices and considerations for California policymakers to extend Medi-Cal coverage and reimbursement for telehealth provided by Federally Qualified Health Centers — even after the COVID-19 pandemic.

Federally Qualified Health Centers and Rural Health Clinics continue to expand across the region. They are also working with hospitals to improve care integration and access to specialty services for Medi-Cal patients.

Following the implementation of the Affordable Care Act, this region, comprising Riverside and San Bernardino Counties, has seen a decrease in people who are uninsured and an increase in people with Medi-Cal coverage. In turn, the number of Federally Qualified Health Centers has grown, and patient visits more than doubled in just a few years.