This report highlights the crucial role that California's 58 counties play in driving all aspects of reform in the state for low-income citizens. It revisits counties six years after the initial 2011 report to measure how state and federal policies have evolved and been implemented in each region. High-level findings of the report include the following:
- County roles and responsibilities for health and healthcare show signficant room for improvement. The report finds that many county roles remain the same "as they have for decades" despite federal reform.
- Counties are still a critical financial driver of Affordable Care Act implementation. Currently, these entities provide the nonfederal Medicaid match for key health programs such as mental health and SUD programs for Medi-Cal services.
- The level and types of funding available to support county initiatives has shifted dramatically in the past few years. New strategies for funding county innovation will be necessary as certain pending policies sunset or new mandates take hold in the upcoming year.