Published Date: June 28, 2017

Diabetes affects nearly 1 of every 10 Californians. A serious side effect of the disease is foot ulcers, which significantly increase a patient's risk of amputation and death. They can be difficult and expensive to treat, and a majority of people with diabetes in the United States do not receive clinically recommended foot health screenings or access podiatric care. In California, Medi-Cal designates podiatric services as optional, limiting access to the complete care spectrum for diabetic beneficiaries.

This policy brief uses Office of Statewide Health Planning and Development (OSHPD) discharge data to project total California expenditures related to lower extremity complications. It is estimated that California spent up to $565 million in 2014 on diabetic foot ulcers and related care. These costs are expected to rise as California's population ages. The authors project that podiatric care reduced California's costs of care in 2014 by between $29 million and $97 million, despite a minority of diabetic patients having received treatment. If a larger percentage of California's diabetic population received similar care, costs could be reduced much further.

With the fate of the Affordable Care Act in limbo, lack of treatment for those enrolled in Medi-Cal or Covered California plans could lead to more hospital admissions and rising costs for the state of California.

The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California. The Center improves the public’s health through high-quality, objective, and evidence-based research and data that informs effective policymaking. The Center is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit

Publication Authors:
  • Jonathan Labovitz
  • Gerald F. Kominski, Ph.D.
  • James Godwin