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Final Evaluation of the Health Care Coverage Initiative in California

January 29, 2014

Research Report

Authors: Gerald F. Kominski, PhD, Nadereh Pourat, PhD, Dylan H. Roby, Ph.D., Ying-Ying Meng, DrPH, Allison L. Diamant, M.D., M.S.H.S., Ana E. Martinez, MPH, Anna C. Davis, Xiao Chen, PhD, Erin Salce, MPH, Wenjiao Lin, MS, Livier Cabezas, M.P.Aff., Nina Hohe, Dimiter Milev

​The UCLA Center for Health Policy Research was selected to evaluate the Health Care Coverage Initiative (HCCI), a ten-county experimental program to extend health care coverage to more than 230,000 low-income uninsured adults who were not otherwise eligible for public programs such as Medi-Cal. This report presents findings based on data received by UCLA from the participating counties as of April 30, 2012 and from DHCS as of July 19, 2012. The report details program implementation and operation, the counties' success in expanding coverage and in expanding the safety-net structure to accommodate the newly insured, innovations in access to, and quality of, care, as well as the program's income and expenditures.

The authors find that the HCCI program demonstrated that with necessary administrative and financial support, counties can develop and operate safety net-based care delivery systems. These systems of care can effectively build on their existing infrastructure and work within their diverse sociopolitical environment, governance structure, resources, geography, and other unique characteristics. Multiple lessons in programmatic innovations such as retention of enrollees, building provider networks, improving access to specialty services, and supporting health information technology are included in the report and attached appendices.

The success of these programs depends on county support of tools and systems required to manage providers and improve enrollee health. The expansion of a comprehensive array of services to a large number of previously uninsured individuals requires efficiencies in care delivery including reshaping provider practices and population care seeking behaviors to reduce the use of higher-cost urgent and emergent services and redirect care to lower cost outpatient settings that better manage the needs of the covered populations.

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