This final report details the outcomes of California's Low Income Health Program (LIHP), a program that was operated by county health systems to provide health coverage for low-income adults who were not eligible for Medi-Cal prior to implementation of the Affordable Care Act.

The evaluation showed that LIHP had a significant impact on safety net system in California by leveraging nearly $5 billion in federal funds to the largest California counties. The funds were used by participating counties in expanding their health system capacity, building robust provider networks, and investing in care coordination. These changes led to a more integrated and patient-centered approach to care delivery.

The evaluation further demonstrated that financial investments in county systems to expand coverage to low-income adults that were not eligible for Medi-Cal prior to the ACA improved access to and quality of care for those individuals as well as led to efficiencies in care delivery in California.

Findings:

• Lower emergency department visits per 1,000 enrollees overtime: from 884 in the first program year to 652 in third program year.
• Lower hospitalization rates per 1,000 enrollees: from 256 in the first program year to 170 in the third program year.

These findings coincided with:

• LIHP enrolled over 1.13 million low-income adults 41% of whom had multiple conditions such as diabetes (13%), asthma and chronic obstructive pulmonary disease (COPD) (8%), dyslipidemia (13%), hypertension (21%), heart disease (4%), or mental health conditions (16%).
• Counties partnered with community-based organizations, network providers, and county staff of health and social service agencies to conduct outreach and enrollee eligible populations. 
• Greater retention of enrollees as measured by 57.1% who remained continuously enrolled during LIHP.
• More visits per 1,000 for enrollees with diabetes (from 6,201 to 6,512) and enrollees with hypertension (6,042 to 6,317) from first to third program year.
• Improved quality of care for patients with diabetes including more annual dilated retinal exams and controlled HgbA1c levels.

The report was prepared for the California Department of Health Care Services and the Blue Shield of California Foundation.