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County Efforts to Expand Health Coverage among the Uninsured in Six California Counties

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Publication Date: February 2002

Publisher(s): Medi-Cal Policy Institute

Author(s): Peter Long

Funder(s): California HealthCare Foundation

Funder(s): California HealthCare Foundation

Topic: Health (Health services for the uninsured)

Type: Book

Coverage: California


For the past 20 years, counties in California have assumed primary responsibility for providing health care to uninsured individuals. In 1999, approximately 6.8 million Californians lacked health insurance coverage. About 2 million of these uninsured individuals (30 percent) are potentially eligible to participate in existing publicly funded programs. However, many adults (4.3 million) and children (350,000) do not meet the income, immigration, or categorical requirements of these programs and are likely to remain uninsured under current federal and state policies.

To address gaps in public coverage at the state level, six California counties have expanded health insurance coverage or created access programs targeting two groups of uninsured individuals. This background paper summarizes major coverage expansions in these six counties (Alameda, Contra Costa, San Francisco, San Joaquin, Santa Clara, and Solano). Specifically, it
identifies similarities and differences among the programs in terms of their target populations, benefits, outreach, enrollment, and retention strategies, and highlights some lessons learned for other counties and the state. Summary tables, which describe the major features of each program and their outreach, enrollment, access, and retention activities, are included at the end of the paper.

Although each county described in this paper has taken a different implementation path, all counties' expansion efforts have targeted either: (1) children who are not eligible for the Medi-Cal or Healthy Families programs or (2) low-income, uninsured adults. Each county has selected the Local Initiative or County Operated Health System (COHS) to administer the new program. Alameda, San Francisco, San Joaquin, and Santa Clara Counties supplemented existing funding streams with a combination of county general revenues, state funding, national tobacco settlement money, Proposition 10 funds, contributions from the Local Initiative, and grants from private foundations. In contrast, Contra Costa and Solano Counties reprogrammed existing state and county funds to improve the organization and delivery of health care services to uninsured adults.