Coverage Initiative


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Low Income Health Program Details


The project was authorized under California's 2010 §1115 Medicaid Waiver (No. 11-W-00193/9). The §1115 Medicaid Waiver makes it possible for counties to obtain federal funds to help cover legal, low-income residents. The authorizing legislation passed by the California Legislature (AB 342) provides a statutory framework for LIHP.

The Waiver authorized LIHP implementation statewide, but participation by counties or other local governmental agencies is voluntary. LIHP will be implemented in a phased expansion starting November 1, 2010. The ten counties that previously participated in the Health Care Coverage Initiative program under California's 2005 Waiver began LIHP implementation on July 1, 2011. Additional local LIHPs will launch on a rolling schedule after that date.
DHCS' LIHP website provides information about how individuals can apply for the local LIHP in their area. 


A central concept aim of the LIHP program is to shift low-income uninsured individuals from more costly episodic care to a more coordinated system of care, thereby improving access to care, quality of care, and overall health.
The specific goals of the program are to:
  • begin early implementation of key coverage expansion components of the Affordable Care Act;
  • promote stability in the health care delivery system;
  • maximize federal funds for care provided to low-income adults;
  • increase efficiency in state and local health care funding; and,
  • promote quality, value, and better health outcomes in the provision of health care services.

Eligibility and Program Design

The basic eligibility criteria for the program were defined in the authorizing §1115 Medicaid Waiver. Eligibility for the LIHP program includes individuals aged 19-64, who are citizens or legal residents (who have lived in the U.S. for over five years), who lack health insurance coverage for services provided by the county or local health authority, and who have family incomes of 200% of FPL or lower.
Family income determines the component of LIHP in which an eligible individual is enrolled.
    • Medicaid Coverage Expansion (LIHP-MCE) provides a broader range of health care services to eligible adults who are aged 19 to 64, with family incomes at or below 133% of FPL, and who may have alternate insurance.
    • Health Care Coverage Initiative (LIHP-CI) provides health care services to eligible adults who are aged 19 to 64, with family incomes above 133% through 200% of FPL, and who are uninsured.

The only modification of eligibility criteria allowed in local programs is decreasing the income threshold for eligibility. Local governments implementing LIHP may elect to limit enrollment by establishing income thresholds below the allowable maximum.

The LIHPs are required to include:

  • a defined provider network for enrolled participants;
  • a benefit package that includes primary and preventive care services as well as specialty care;
  • case management and/or disease management services for certain chronic conditions;
  • monitoring of quality of care indicators; and,
  • health information systems such as registries and/or electronic health records.

LIHP Evaluation

An evaluation of the LIHP program was required by the authorizing waiver and legislation. The evaluation was designed to measure the success of the program in meeting the program goals.