Policy Brief

Federally Qualified Health Centers--commonly referred to as Community Health Centers (CHCs)--serve as a safety net for people who did not gain health insurance under the Affordable Care Act (ACA), including those immigrants not eligible for Medicaid or health insurance exchange coverage. ACA-driven changes in health insurance coverage, funding, and related policy have created new challenges for these safety net organizations. This policy brief reports the findings from analyses of the U.S. HRSA Uniform Data System and interviews conducted in 2014-16 with the leadership of 31 CHCs...

In California, personal health care expenditures are estimated to total more than $367 billion in 2016. Approximately 71 percent of these expenditures will be paid for with public funds (i.e., taxpayer dollars). This estimated contribution of public funds to health care expenditures is much higher than estimates that include only major health insurance programs such as Medicare and Medicaid. Several additional public funding sources also contribute to health care expenditures in the state, including government spending for public employee health benefits, tax subsidies for employer-sponsored insurance and the Affordable Care Act (ACA) insurance exchange, and county health care expenditures...

Despite the high rate of untreated tooth decay, many young children in California under six years of age have never been to a dentist. Numerous and complex barriers to access to oral health care for young children exist, and a multifaceted approach is required to improve receipt of preventive and treatment services that could improve the oral health of this population. This policy brief describes the UCLA-First 5 LA 21st Century Dental Homes Project, which was designed to improve oral health care for young children in 12 Federally Qualified Health Center (FQHC) clinic sites with co-located dental and primary care services and its accessibility in their service areas throughout Los Angeles County...

In late 2015, California passed the End of Life Option Act (AB 15), which allows residents at the terminal stage of an illness to request a prescription for medications meant to hasten death. As California seeks to implement the law in June 2016, findings from other states that practice aid in dying (AID) may guide implementation. This policy brief provides an overview of the use of AID, outlines outstanding questions about practice and ethics, and recommends steps for improving California's implementation of AB 15...

Data from the California Health Interview Survey (CHIS) from 2011--2013 showed approximately 90,000 veterans had mental health needs and 200,000 reported serious thoughts of suicide during the 12 months prior to participating in CHIS. Although the proportion of veterans reporting mental health need or serious psychological distress was no higher than the general population, California veterans were more likely to report lifetime suicide ideation. This policy brief uses CHIS data to examine the mental health status, needs, and barriers to care among veterans in California...

Secondhand smoke is dangerous to a person's health at any level of exposure. Yet policies that prevent smoking are not in place for a majority of market-rate multi-unit housing complexes, according to a new survey of nearly 1,000 apartment dwellers in the city of Los Angeles. Approximately 37 percent of respondents reported that secondhand smoke had drifted into their apartments in the past year. Households with members of vulnerable populations, such as children or individuals with chronic conditions, are more likely to report smoke drifting from adjacent units...

In California, more than 13 million adults (46 percent of all adults in the state) are estimated to have prediabetes or undiagnosed diabetes. An additional 2.5 million adults have diagnosed diabetes. Altogether, 15.5 million adults (55 percent of all California adults) have prediabetes or diabetes. Although rates of prediabetes increase with age, rates are also high among young adults, with one-third of those ages 18-39 having prediabetes. In addition, rates of prediabetes are disproportionately high among young adults of color, with more than one-third of Latino, Pacific Islander, American Indian, African-American, and multiracial Californians ages 18-39 estimated to have prediabetes...

Community Health Centers (CHCs) are one of the principal safety-net providers of health care for low-income and uninsured populations. Co-locating dental services in primary care settings provides an opportunity to improve access to dental care. Yet this study of California CHCs that provide primary care services shows that only about one-third of them co-located primary and dental care services on-site. An additional one-third were members of multisite organizations in which at least one other site provided dental care...

More than three-quarters of a million (772,000) older Californians are among the "hidden poor"--older adults with incomes above the federal poverty line (FPL) but below a minimally decent standard of living as determined by the Elder Economic Security Standard™ Index (Elder Index) in 2011. This policy brief uses the most recent Elder Index calculations to document the wide discrepancy that exists between the FPL and the Elder Index. This study finds that the FPL significantly underestimates the number of economically insecure older adults who are unable to make ends meet...

Positive role models, social and community activities, and school support are protective social factors that promote youth health and well-being. Latino, African-American, Asian, multi-racial, and low-income adolescents are less likely to experience these protective social factors compared to other groups, which may contribute to health disparities. Adolescents who identify a role model, volunteer, participate in organizations outside of school, or experience high levels of teacher or other adult support at school engage in greater physical activity and are more likely to have a healthy weight...

This policy brief presents 10-year trends in several key health and wellness indicators for children ages 0-5 in California. These indicators are health insurance coverage; source of medical care; dental visits; overweight-for-age; parents singing and reading to their child and going out with the child; and preschool attendance. The data are from the California Health Interview Survey (CHIS), the largest state health survey in the U.S. The survey gathers information on a range of health behaviors and health conditions, as well as on access to health care among children, adolescents, and adults in California...

More than 70 percent of behavioral health conditions are first diagnosed in the primary care setting. Yet physical and behavioral health care are typically provided separately, compelling many vulnerable patients to navigate the complexities of two separate systems of care. This policy brief examines five community health centers (CHCs) in California that have taken preliminary steps toward creating "one-stop shopping" for both physical and behavioral health care. The steps taken to increase integration by the CHCs include employing behavioral health providers, using a single electronic health record that includes both physical and behavioral health data, transforming the physical space, and developing mechanisms for effective transition of patients between providers...

Falls are the leading injury-related cause of death and of medical care use among Californians ages 65 and over. In 2012, there were 1,819 deaths due to falls among older Californians. More than 72,000 hospitalizations were caused by fall injuries among older adults during that year, along with more than 185,000 emergency department (ED) visits. The medical costs alone of falls in the state have been estimated to be over $2 billion annually. Those who have fallen more than once are at the highest risk of injury and further falls...

The Affordable Care Act (ACA) has already resulted in expanded eligibility for Medicaid in 27 states, including California, as of 2014. One major concern about the Medicaid expansion is that a high level of need among the newly eligible may lead to runaway costs, which could overwhelm state budgets when federal subsidies no longer cover 100 percent of the expansion population's costs in 2017. Although cost increases as a result of the newly eligible are likely, an even more important question is whether these increases will be temporary or permanent...

This policy brief reports the findings of a systematic review conducted by the Community Health Innovations in Prevention for Seniors (CHIPS) project. The project identified successful programs for increasing the use of two or more clinical preventive services for vulnerable, underserved populations ages 50 years and older within community settings. The CHIPS project also used the RE-AIM Framework to evaluate the readiness and feasibility of implementing these programs within real-world settings. Policy recommendations focus on expanding and sustaining clinical preventive services in the community and reaching diverse populations, bridging the traditional silos of clinical care and community-based services, and providing financial incentives to clinical providers and community-based organizations to support preventive services coverage...

More than 300,000 California children ages 4 to 11 have mental health needs, yet only one-fourth of them received mental health care in 2007 and 2009. Health insurance coverage and a usual source of care typically facilitate mental health service use; however, this is not the case for children with mental health needs. This policy brief identifies children at risk for mental health needs and highlights some barriers to their receiving mental health services. Childhood is a vital time for the promotion of positive mental health among children, as well as for supporting at-risk families in order to avert the early onset of some disorders and help reduce the severity of others...

Community health centers (CHCs) are a cornerstone of the health care safety net. They are the primary source of care for many low-income populations, including both those newly insured under the Affordable Care Act (ACA) and those who were left out and will remain uninsured. The ACA provides challenges and opportunities for CHCs, which will require significant changes in infrastructure and care delivery approaches to meet those challenges. This policy brief assesses the progress made by CHCs in Los Angeles County in meeting a number of key indicators of ACA readiness in early 2014...

Increasing diabetes prevalence has been found to be a primary driver of increased health care costs in the United States. This policy brief examines the impact of diabetes on hospitalizations and related hospitalization costs in California. Using 2011 hospital patient discharge data and annual financial data from the Office of Statewide Health Planning and Development (OSHPD), this study found that patients with diabetes represented 31 percent of hospitalizations in California in 2011 among patients 35 years or older, including 39 percent of African-American and Asian-American patients and 43 percent of Latino patients...

More than 35,000 dentists were licensed to practice in California in 2012, a number higher than in any other state and representing about 15.6 percent of the total number of dentists nationwide. Despite these numbers, concerns over a sufficient supply of dentists in the state have not diminished. These concerns are due in part to the uneven distribution of dentists in areas with the highest level of need, as well as to demographic and practice characteristics that may limit availability of the dental workforce...

This policy brief looks at the financial burdens imposed on older Californians when adult children return home, often due to a crisis not of their own making, to live with their parents. The findings show that on average in California, the amount of money that older adults need in order to maintain a minimally decent standard of living while supporting one adult child in their home increases their expenses by a minimum of 50 percent. Low-income older adults are usually on fixed incomes, so helping an adult child can provide the child with a critical safety net but at the cost of the parents' own financial well-being...