In this paper we look at six Southern California counties, their implementation of the Affordable Care Act and care and financing for the remaining uninsured in the local safety nets. The landscape has changed swiftly and dramatically from large numbers of uninsured seeking care in over-burdened and under-financed county health systems to large numbers of newly insured seeking care through Medi-Cal managed care plans, whose enrollments and responsibilities have grown very quickly.
We look at the following key areas and make a set of recommendations at the federal, state, local, and where applicable, employer level:
- Who are the Remaining Uninsured, and how is that changing?
- What do the safety net delivery systems look like by county, and how are they evolving?
- How are these systems financed, and how is that changing?
- What are the opportunities and perils in care for the remaining uninsured, and how are local safety nets responding?