California’s San Joaquin Valley — spanning the counties of Fresno, Kings, Madera, Mariposa, and Tulare — is the food bowl of California and the nation. Although the region’s fertile farmland helps feed families across the country, more than 1 in 5 children experience food insecurity in Fresno County, the region’s urban hub with more than a million residents. Over half the region’s population relies on Medi-Cal for health coverage, another 7.6% are uninsured, and almost 1 in 5 people live in poverty. At the same time, there are pockets of affluence.

Findings: 

• Some hospitals in the San Joaquin Valley experienced a financial downturn during the COVID-19 pandemic, largely brought about by declining inpatient volumes and higher staffing costs. 
• A large independent practice association (IPA) launched, and national hospitalist groups entered the market. 
• Community health centers (CHCs), which are mostly FQHCs, provide bedrock access to outpatient care, adding sites and serving more patients per capita than CHCs in other study regions and statewide.  The region continues to struggle with chronic shortages across the spectrum of health care professionals.
• State Medi-Cal transformation initiatives have brought new benefits and sorely needed behavioral health infrastructure investments.
• Widespread anxiety exists about the coming federal Medicaid budget cuts and policy changes, especially coming on the heels of state cuts to balance the budget. 

This report uses 2018–2019, 2022–2023, and 2024 California Health Interview Survey (CHIS) data on general health status, medical debt, uninsurance.