Safety Net Delivery System Redesign in California: Innovations in the Low Income Health Program (LIHP)

​This report examines the success and challenges of the Low Income Health Program (LIHP) in California.  It combines earlier assessments of 10 counties that participated in the Health Care Coverage Initiative (HCCI) program, a precursor to the LIHP, along with a survey of LIHP program administrators and a survey of primary care providers within LIHP networks to assess system redesign efforts during LIHP. In addition, the report includes responses from 60 clinics in HCCI counties and six new LIHPs (Riverside, San Bernardino, Santa Cruz, San Joaquin, Placer, and the County Medical Services Program, or CMSP, a consortium of 35 mostly rural counties) that implemented their programs prior to August 1, 2012.

The findings indicate that LIHPs not only succeeded in implementing the program as intended but also went beyond defined program criteria to enact innovative strategies that changed health care delivery in California’s safety net system. These innovations included developing robust provider networks and centralized support systems, promoting changes in provider and patient behavior, and integrating physical and behavioral health care. The success of LIHPs in system redesign through these strategies and innovations will benefit many parties, including LIHP enrollees who are eligible for coverage through the Affordable Care Act (ACA), safety net providers who participated in LIHP, California counties that implemented LIHP, and managed care plans and commercial providers that will insure and provide care to LIHP enrollees through the ACA.

This report was supported by the California Department of Health Care Services, the Blue Shield of California Foundation, and the California Medicaid Research Institute.

• Nadereh Pourat, PhD
• Dylan H. Roby, PhD
• Livier Cabezas, M.P.Aff.
• Max W. Hadler, MPH, MA
• Erin Salce, MPH
• Diana Hilberman
• Gerald F. Kominski, Ph.D.