Existing law requires each county to provide aid, commonly known as a general assistance program, to the countys indigent residents who are not supported by other means and are ineligible for the Medi-Cal program, as specified. Existing law sets forth various provisions relating to county-based health care services for indigent individuals and to reporting systems for those services.

This bill would require the State Department of Health Care Services, by July 1, 2027, to establish an internet website where the public can access information on safety-net health care services in the state. The bill would require that the website include certain information and resources, including, among other items, information about each county medically indigent health care program for uninsured individuals, that provides health care to low-income county residents who are uninsured or underinsured, including eligibility requirements, the cost structure for applicants, and other specified elements. The bill would require the department, in consultation with certain entities, to review the information and resources on the website, as specified.

The bill would require each county to submit any changes to the above-described elements to the department within 120 calendar days, as specified. By creating new data-reporting duties for counties, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law requires each county to provide aid, commonly known as a general assistance program, to the countys indigent residents who are not supported by other means and are ineligible for the Medi-Cal program, as specified. Existing law sets forth various provisions relating to county-based health care services for indigent individuals and to reporting systems for those services.

This bill would require the State Department of Health Care Services, by July 1, 2027, to establish an internet website where the public can access information on safety-net health care services in the state. The bill would require that the website include certain information and resources, including, among other items, information about each county medically indigent health care program for uninsured individuals. individuals, including eligibility requirements, the cost structure for applicants, and other specified elements. The bill would require the department, in consultation with certain entities, to review the information and resources on the website, as specified.

The bill would require each county, no later than January 1, 2028, to prepare and submit to the department a plan to operate programs to provide health care to medically indigent individuals. The bill would require that the plan include information on projected caseload and expenditure increases and projected investment, as specified. By creating new planning county to submit any changes to the above-described elements to the department within 120 calendar days, as specified. By creating new data-reporting duties for counties, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law requires each county to provide aid, commonly known as a general assistance program, to the countys indigent residents who are not supported by other means and are ineligible for the Medi-Cal program, as specified. Existing law sets forth various provisions relating to county-based health care services for indigent individuals and to reporting systems for those services.

This bill would require the State Department of Health Care Services, by July 1, 2027, to establish an internet website where the public can access information on safety-net health care services in the state. The bill would require that the website include certain information and resources, including, among other items, information about each county medically indigent health care program for uninsured individuals. The bill would require the department, in consultation with certain entities, to review the information and resources on the website, as specified.

The bill would require each county, no later than January 1, 2028, to prepare and submit to the department a plan to operate programs to provide health care to medically indigent individuals, as necessary to meet additional need due to reduced access to health care coverage. individuals. The bill would require that the plan include information on projected caseload and expenditure increases, increases and projected investment, and assessment of funding sources, as specified. By creating new planning duties for counties, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law requires each county to provide aid, commonly known as a general assistance program, to the countys indigent residents who are not supported by other means and are ineligible for the Medi-Cal program, as specified. Existing law sets forth various provisions relating to county-based health care services for indigent individuals and to reporting systems for those services.

This bill would require the State Department of Health Care Services, by July 1, 2027, to establish an internet website where the public can access information on safety-net health care services in the state. The bill would require that the website include certain information and resources, including, among other items, information about each county medically indigent health care program for uninsured individuals. The bill would require the department, in consultation with certain entities, to review the information and resources on the website, as specified.

The bill would require each county, no later than January 1, 2028, to prepare and submit to the department a plan to operate programs to provide health care to medically indigent individuals, as necessary to meet additional need due to reduced access to health care coverage. The bill would require that the plan include information on projected caseload and expenditure increases, projected investment, and assessment of funding sources, as specified. By creating new planning duties for counties, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

SENATE COMMITTEE ON

Senator Sabrina Cervantes, Chair

2025 - 2026 Regular Session

AB 2368 (Bonta) - Low-income health care: internet website and information

Bill Summary:

AB 2368 would require the Department of Health Care Services (DHCS) to establish an internet website where the public can access information on safety-net health care services in the state.

Fiscal Impact:

• Unknown ongoing General Fund costs, potentially hundreds of thousands, for the DHCS to establish and maintain the internet website.
• Unknown ongoing costs to counties to report information to the DHCS. Costs to counties may be potentially reimbursable by the state, subject to a determination by the Commission on State Mandates.

Background:

H.R. 1 (Public Law No 119-21). The Medi-Cal program provides health care services to qualified low-income individuals. The Medi-Cal program is primarily governed by the federal Medicaid program. H.R. 1 made a number of program changes that restrict eligibility and funding for the federal Medicaid program. This is expected to result in the loss of Medi-Cal coverage for a significant number of individuals. Changes include, but are not limited to:

• Work requirements. The new “community engagement requirements” (or “work requirements”) require nondisabled adults between the ages of 19 and 65 who gained coverage through the federal Affordable Care Act (“ACA expansion adults”) to demonstrate 80 hours of work, education, or volunteer activities in order to be eligible for Medicaid coverage, unless they qualify for a limited exemption.
• Semiannual eligibility redeterminations. H.R. 1 requires an eligibility redetermination process every 6 months for nondisabled adults between the ages of 19 and 65 who gained coverage through the federal Affordable Care Act (“ACA expansion adults”). Prior to the enactment of H.R. 1, the federal Medicaid program required the eligibility of all Medicaid recipients to be renewed once every 12 months or when the recipient reported a change in circumstances.

Safety-Net Health Care Programs. California has a number of safety-net health care programs that provide services to uninsured or underinsured individuals, including:

• Condition-specific screening or treatment health programs administered by DHCS for uninsured and underinsured individuals, including Family PACT which provides family planning services, the Every Women Counts program to provide breast and cervical cancer screening, the Breast and Cervical Cancer Treatment Program to provide breast and cervical cancer treatment, the California Prostate Cancer Treatment Program to provide prostate cancer treatment, and the Genetically Handicapped Persons Program which provides coordinated care to adults with specific diseases.
• Counties must support residents who are low-income or incapacitated who are not otherwise supported by relatives, friends, their own means, or state or private institutions. This obligation has been interpreted by courts to require counties to provide subsistence medical care to those who cannot afford it.
• Hospital emergency departments must provide emergency screening and stabilization services without regard to the patient’s insurance status or ability to pay.
• Hospitals must have charity care or discount payment policies for uninsured or underinsured patients with incomes below 400 percent of the federal poverty level.
• A “free clinic” is a nonprofit clinic that does not charge patients and a “community clinic” is a nonprofit clinic that only charges patients based on the patient’s ability to pay, utilizing a sliding scale.

Proposed Law:

Specific provisions of the bill would:

• Require DHCS, in order to ensure that people have accurate and comprehensive information when accessing safety-net health care services in California, to establish an internet website where the public can access information on safety-net health care services in the state.
• Require the internet website to include all of the following information and resources:
  • A person’s legally protected right to emergency medical care under state and federal law.
  • Payment support resources, including coverage options, state programs, hospital charity care, and other assistance that is available to help people access health care services.
  • Information about each county program that provides health care to low-income county residents who are uninsured or underinsured, as specified.
  • Any other information or resources that will assist an individual seeking comprehensive and accurate information about accessing affordable health care services in the state.
• Require the DHCS, in consultation with specified entities, to review the information and resources on the internet website to ensure that it is current and updated at reasonable intervals, but no less than once annually.
• Require each county to submit any changes to specified elements of county programs to the DHCS within 120 calendar days after either approval by the county’s board of supervisors or an administrative or regulatory change, whichever is applicable.

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SENATE COMMITTEE ON HEALTH

Senator Akilah Weber Pierson, Chair

BILL NO: AB 2368

SUBJECT: Indigent health care: internet website and information

SUMMARY:

Requires the Department of Health Care Services to establish a website with public information about safety-net health care services in the state, including specified information about each county health care program for uninsured individuals.

Existing federal law:

1. Establishes the Medicaid program to enable each state to furnish medical assistance on behalf of individuals whose income and resources are insufficient to meet the costs of necessary medical services. [42 USC §1396, et seq.]
2. Starting January 1, 2027, as enacted by H.R. 1 (Public Law No. 119-21), requires individuals with incomes below 138% of the federal poverty level (FPL) who are under age 65, not pregnant, and have no Medicaid-eligible dependents to:
   1. Have their eligibility for Medicaid additionally redetermined every six months; and,
   2. Demonstrate community engagement through at least 80 hours of work, community service, or participation in a work program, or at least half-time participation in an educational program, or have a monthly income not less than 80 times the federal minimum wage in a specified month. Provides for some exceptions to this requirement. This is referred to as the “work and community engagement” requirements. [42 USC §1396a]
3. Starting October 1, 2026, as enacted by H.R. 1, limits Medicaid payments to states for individuals who are not citizens or nationals of the U.S., lawful permanent residents, Cuban or Haitian entrants, or individuals lawfully residing in the U.S. in accordance with a Compact of Free Association. [42 USC §1396b]

Existing state law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. [WIC §14000, et seq.]
2. Establishes a number of condition-specific screening or treatment health programs administered by DHCS for uninsured and underinsured individuals with incomes below 200% of FPL including the State-Only Family Planning Program (known as Family PACT) to provide family planning services; the Every Women Counts program to provide breast and cervical cancer screening; the Breast and Cervical Cancer Treatment Program to provide breast and cervical cancer treatment; and the California Prostate Cancer Treatment Program to provide prostate cancer treatment. Establishes the Genetically Handicapped Persons Program, administered by DHCS, which provides coordinated care to adults with specific diseases of any income level. [WIC §24007, et seq.; HSC §104160, et seq.; HSC §104160, et seq.; HSC §104322, et seq; and HSC §125175]
3. Requires counties to support residents who are low-income or incapacitated who are not otherwise supported by relatives, friends, their own means, or state or private institutions. This obligation has been interpreted by courts to require counties to provide subsistence medical care to those who cannot afford it. [WIC §17000]
4. Requires hospital emergency departments, under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) and also under similar provisions of state law (state EMTALA), to provide emergency screening and stabilization services without regard to the patient’s insurance status or ability to pay. Federal EMTALA imposes this requirement on any hospital that participates in Medicare. State EMTALA imposes this requirement on any hospital that operates an emergency department. [42 USC §1395dd and HSC §1317]
5. Requires hospitals to have charity care or discount payment policies for uninsured or under insured patients with incomes below 400% of FPL. [HSC §127400]
6. Defines a “free clinic” as a nonprofit clinic that does not charge patients and a “community clinic” as a nonprofit clinic that only charges patients based on the patient’s ability to pay, utilizing a sliding scale. [HSC §1204]

This bill:

1. Requires DCHS to establish a website where the public can access information on safety-net health care services in the state that includes information on the right to emergency medical care under state and federal law, payment support resources such as coverage options, state programs, hospital charity care, and information, resources, or other assistance available to help people access health care services, and all of the following information about each county medically indigent health care program:
   1. All eligibility requirements, including age, residency requirements, and income limits;
   2. The cost structure for applicants;
   3. The telephone number to reach the appropriate county program administrator; and,
   4. A hyperlink or Uniform Resource Locator (URL) for each county internet website related to safety-net services or medically indigent programs.
2. Requires DHCS to consult with the California State Association of Counties, organizations advocating for consumers’ access to health care, and other entities with expertise in health care for medically indigent individuals, as determined by DHCS.
3. Requires the website to have mobile capabilities and comply with existing federal law and regulation on disability access, existing state law on language access, and requires the information and resources be made available in a manner that is accessible to all state residents. Requires DHCS, in consultation with the stakeholders, to review the information and resources on the website to ensure it is current and updated at least annually.
4. Requires each county to submit any changes regarding its medically indigent health care program to DHCS within 120 days of the approval by the board or other administrative change.
5. Requires reimbursement from the state to counties if the Commission on State Mandates determines that this bill contains costs mandated by the state.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, the County Health Executives Association of California notes costs in the tens of thousands to hundreds of thousands of dollars per county, overwhelmingly related to staff time. Total cost for all counties could be in the low millions of dollars. If the Commission on State Mandates determines the provisions of this bill creates a new program or imposes a higher level of service for which the state must reimburse local costs, counties could claim reimbursement from the state (General Fund). Costs to DHCS of an unknown mount, potentially in the low hundreds of thousands of dollars to establish and maintain the website (General Fund).

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, under H.R. 1, California is bracing for a surge in uninsured residents, with counties estimating that indigent programs will experience new enrollment of between 417,000 and 1.3 million. When federal policies restrict eligibility, introduce intentional barriers to enrollment, or roll back coverage, people don’t simply stop getting sick. Instead, they fall into our county safety nets to be the provider of last resort. Without a coordinated, statewide strategy to collect safety net program eligibility and contacts into a single platform to connect people to care, we risk leaving our most marginalized communities without life-saving care. This bill establishes a vital framework for transparency, access, and proactive planning to bridge the gap left by federal attack. We cannot wait for federal cuts to dismantle our health care safety net before we decide to act.
2. H.R. 1. H.R. 1, a vast budget reconciliation bill, makes a number of changes primarily to lower taxes, increase funding for immigration control and national defense, and restrict access to and funding for SNAP and Medicaid. Medicaid payments were reduced by defunding family planning providers that provide abortions, prohibiting new or increased provider taxes to fund Medicaid and requiring a gradual reduction of existing provider taxes, capping the rate the state may set for certain services, reducing the federal share of payment for emergency services to adults with unqualified immigration status, and making changes in allowable payments under federal waiver programs. More relevant to this bill are a number of changes to the Medicaid eligibility rules, which were enacted to reduce the number of people receiving assistance through the Medicaid program.
3. Work requirements. The new “community engagement requirements” (or “work requirements”) require nondisabled adults between the ages of 19 and 65 who gained coverage through the Affordable Care Act (“ACA expansion adults”) to demonstrate 80 hours of work, education, or volunteer activities a month to be eligible for Medicaid coverage, unless they qualify for a limited exemption. States are required to verify that an individual meets the community engagement requirements twice a year, starting January 1, 2027.
4. Semiannual eligibility redeterminations. Under current federal regulation and state law, Medi-Cal eligibility must be redetermined once every 12 months or whenever an individual reports a change in circumstances. H.R. 1 requires an additional eligibility renewal process every six months for the same group of ACA expansion adults that the work requirements apply to, starting January 1, 2027.
5. Reduced federal funding for previously qualified immigrants. H.R. 1 also ends the availability of full-scope federal Medicaid funding for additional groups of immigrants who are lawfully present, including refugees, asylees, victims of trafficking and others under humanitarian immigration statuses, starting October 1, 2026. The state can only continue to provide for full-scope Medi-Cal for these populations by paying for the entirety of their care, with the exception of emergency and pregnancy services.
6. Impacts of H.R. 1 eligibility barriers. The UC Berkeley Labor Center estimates that 1.87 million adults will lose coverage due to the work requirements, and 270,000 will lose coverage due to the semiannual eligibility redeterminations. The most recent estimate from DHCS in the “Implementation Plan for New Federal Eligibility and Enrollment Changes Under H.R. 1,” released on January 29, 2026, estimates up to 1.8 million will lose coverage due to work requirements, increased renewals, and the normal churn of individuals transitioning from Medi-Cal to Covered California. DHCS has also shared that approximately 200,000 immigrants will no longer have satisfactory immigration status due to the H.R. 1 change regarding immigrant eligibility and, according to the current Governor’s budget proposal, will lose full-scope Medi-Cal. These numbers are somewhat in flux now that the Centers for Medicare and Medicaid Services have released an interim final rule interpreting the work or community engagement requirements that indicate that certain exemptions will be interpreted more narrowly than expected, so the numbers could be even higher. This bill requires DHCS to create a website to ensure individuals seeking safety-net health care services outside of Medi-Cal have comprehensive information.
7. Health care for the remaining uninsured. Individuals who lose Medi-Cal will have limited options to otherwise obtain health care. Very few of these individuals will be eligible for subsidies through Covered California, as it has similar restrictions on immigration status, a lower income cap, and H.R. 1 also specified that individuals losing Medicaid due to work requirements are not eligible for subsidies to purchase coverage through a state Exchange like Covered California. As a result, the remaining options in California are the handful of condition-specific coverage programs that generally offer coverage for very limited health services, the safety net programs run by each county as part of their statutory obligations to support low-income residents who cannot afford health care, or to self-pay. Free clinics or community clinics offer free care or sliding scales to people who cannot afford care and general acute care hospitals in California are required to offer charity care or discount payment programs to patients earning less than 400% of FPL. However, while hospitals must offer discounts for the care they provide, in general, they are not obligated to provide services to individuals without coverage, unless they are in a medical emergency. It should be noted that both clinics and hospitals are also facing funding cuts due to various provisions of H.R. 1 affecting health care financing and Medi-Cal eligibility.

Prior to the implementation of the ACA in 2014, which expanded Medi-Cal to previously ineligible adults and established Covered California as a more affordable option for purchasing health coverage, county safety net programs played a much larger role in health care for the uninsured. According to a March 2026 report by the Legislative Analyst’s Office, over the years, court decisions have clarified that these health care programs are required to provide only the basic care necessary to prevent serious harm, pain, or infection. Programs are not required to provide specific benefits, so the minimum level of service required is significantly less than what is provided by other public programs such as Medi-Cal. Counties are also able to set income-eligibility requirements based on subsistence living costs and an individual’s ability to pay. These requirements may take the form of cost-sharing arrangements with a sliding scale depending on an individual’s income. While counties previously had specific funding through revenues derived from state sales tax and a vehicle license fee (known as the realignment formula), in 2013, the state revised realignment formulas due to the expansion of health care under the ACA to redirect a significant portion of these revenues to offset state General Fund costs for CalWORK’s cash aid grants to very low-income families as well as account for the new state costs of the Medi-Cal expansion through AB 85 (Committee on Budget, Chapter 24, Statutes of 2013). According to a September 2025 issue brief by the California Health Care Foundation, as a result of the expansion of Medi-Cal, while many counties continue to operate these programs, now often covering people with higher incomes, some counties have closed their programs completely. Many do not cover immigrants who do not have qualified immigration status for other programs. Given the change in funding and the expected large numbers of newly uninsured individuals, it is far from certain that counties will be able to pay for the health services these individuals need. Nonetheless, counties are still obligated to cover subsistence medical care.

1. Related legislation. SB 987 (Weber Pierson) would have created the California Health Access Fund to redirect any savings to the state resulting from decreased enrollment in the Medi-Cal program caused by the implementation of recently enacted federal enrollment barriers and required moneys in the fund to be used to ensure that California residents losing health coverage can continue to receive health care services and that health care providers are reimbursed for these services. SB 987 was held on suspense in the Senate Appropriations Committee.
2. Prior legislation. AB 85 (Committee on Budget, Chapter 24, Statutes of 2013), redirected county realignment funds to the state according to various formulas in different counties due to declining enrollment in county health programs as a result of the expansion of Medi-Cal under the ACA.
3. Support. Health Access California writes that there is currently no state entity that compiles and displays for Californians relevant information about how to access county-provided health services. In fact, this is a role that many nonprofits end up playing, including Health Access on several occasions. This has involved direct outreach to each individual county to get updates on their programs, who they are serving and where individuals can find information; in many cases this information was not readily available online. Given the difficulty for advocates in tracking down this information, it is certainly not accessible to the consumers who most need resources.
4. Amendments. The author and committee have agreed to a number of technical amendments that modernize program description and refine the required elements about county health care programs:

Section 1, 17031(a)(3)

(3) Information about each county medically indigent health care program for uninsured individuals that provides health care to low-income county residents who are uninsured or underinsured, including, but not limited to, all of the following:

(A) All eligibility requirements, including age, citizenship or immigration status requirements, residency requirements, and income and other resource limits.

(B) The cost structure for applicants.

(C) The telephone number to reach the appropriate county program administrator obtain information about the program.

(D) A hyperlink or Uniform Resource Locator (URL) for each county internet website related to safety-net services or medically indigent programs.

(E) Whether use of the program is subject to repayment and by what means the county may collect.

(4) Any other information or resources that will assist an individual seeking comprehensive and accurate information about accessing medically indigent affordable health care services in the state.

(c) The department shall consult with the California State Association of Counties, organizations advocating for consumers’ access to health care, and other entities with expertise in health care for medically indigent individuals low-income Californians, as determined by the department.

SUPPORT AND OPPOSITION:

Support: California Academy of Family Physicians
California Association of Medical Product Suppliers
California Chapter of the American College of Emergency Physicians
Desert Healthcare District and Foundation
Disability Rights California
Drug Policy Alliance
Health Access California
Western Center on Law & Poverty, Inc.

Oppose: None received.

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ASSEMBLY THIRD READING

ATR Bill Id:AB 2368

Author:(Bonta)

As Amended Ver:April 16, 2026

Majority vote

SUMMARY

Requires the State Department of Health Care Services (DHCS), by July 1, 2027, to establish an internet website where the public can access specified information on safety-net health care services in the state, including: all eligibility requirements; cost of services; telephone number to reach the appropriate county program administrator; a hyperlink or Uniform Resource Locator (URL) for each county internet website related to safety-net services or medically indigent programs; and any other information or resources that will assist an individual seeking information about accessing medically indigent health care services. Requires each county to prepare and submit to DHCS a plan to operate programs to provide health care to medically indigent individuals.

Major Provisions

COMMENTS

County indigent care programs. Welfare and Institutions Code (WIC) Section 17000 was codified in 1965. It requires counties to "relieve and support all incompetent, poor, indigent persons, and those incapacitated by age, disease, or accident, lawfully resident therein, when such persons are not supported and relieved by their relatives or friends, by their own means, or by state hospitals or other state or private institutions." However, this language by no means guarantees a meaningful health care safety net for millions of Californians who may lose coverage.

County indigent care programs generally do not offer "coverage," they instead directly provide or pay for a limited set of health care services. Case law establishes some basic responsibilities of counties for indigent care, but eligibility and service levels largely depend on county resources and priorities. Few counties provide care for Californians without legal immigration status, and Section 17000 does not require it. Programs are funded largely with state realignment funds provided to counties. Because demand for indigent care services had declined over the last decade, commensurate with expanded Medi-Cal and Covered California eligibility, counties explain these programs now lack both the resources and the infrastructure to handle significantly increased demand.

According to the Legislative Analyst's Office (LAO), court decisions have clarified that indigent health care programs are required to provide only the basic care necessary to prevent serious harm, pain, or infection. Programs are not required to provide specific benefits, so the minimum level of service required is significantly less than what is provided by other public programs (such as Medi-Cal). Counties are also able to set income-eligibility requirements based on subsistence living costs and an individual's ability to pay. These requirements may take the form of cost-sharing arrangements with a sliding scale depending on an individual's income.

Prior to the passage of the Patient Protection and Affordable Care Act (ACA), there were an estimated 850,000 enrolled in county indigent health care programs across the state. As the state has expanded Medi-Cal eligibility (to mostly childless adults and undocumented individuals), county indigent health care caseload has decreased, with counties estimating around 10,000 individuals currently enrolled. However, the number of enrollees per county can vary widely due to the broad county discretion over their programs. As enrollment in county indigent health programs declined as access to other health coverage for low-income individuals increased significantly, many counties have broadened their eligibility requirements to include additional participants and/or the scope of the benefits offered by their indigent care programs, as available resources allow. For example, some counties have chosen to accept individuals with unsatisfactory immigration status (UIS) or provide certain specialty care beyond the basic level of care required in statute.

County Medical Services Program (CMSP). According to the California Health Care Foundation's (CHCF) recent issue brief, "Covering the Uninsured," the CMSP continues to operate in 35 mostly small and rural counties, providing health coverage for uninsured low-income, indigent adults age 21–64 with incomes under 300% of the federal poverty level (FPL) who are not otherwise eligible for other publicly funded health care programs, notably Medi-Cal. A governing board sets policy for the program, and each county contracts with CMSP to provide services in that county. The CMSP does cover residents with UIS. The covered benefits, while broad, are not comprehensive (e.g., pregnancy-related services and long-term care are not included). Services are subject to prior authorization and medical necessity requirements, a share of cost, and some benefit limits. Interested people enroll through county health and human services departments. Starting in 2020, the CMSP added the Connect to Care program offering preventive health services and prescription drugs, with enrollment directly through participating community providers such as clinics and pharmacies.

AB 85. In 2014, after implementation of the ACA, particularly the expansion of Medi-Cal to childless adults up to 138% of the FPL, the state made adjustments to realignment revenues supporting county indigent programs to account for the newly expanded Medi-Cal population that would no longer need to be covered at the county level. AB 85 (Committee on Budget), Chapter 24, Statutes of 2013, redirected realignment funds according to various formulas in different counties. For the thirty-four largely rural counties participating in CMSP, AB 85 required 60% of health realignment funding that would have been received to be redirected to the state. The 12 public hospital counties and the remaining 12 counties were able to choose whether to have 60% of realignment redirected, or to use a formula-based approach that takes into account a county's cost and revenue experience. All but four of those counties chose a formula-based approach.

HR 1 impacts. The LAO estimates that by 2030, nearly 2 million individuals could be disenrolled from Medi-Cal due to new eligibility requirements (effectively doubling the number of uninsured individuals). Many of these individuals may have difficulty finding other sources of health coverage and may therefore seek care through county indigent care programs. The LAO estimates anywhere between 20% and 50% (400,000 to 1 million) of these individuals may enroll in county indigent health care programs, though these estimates are highly uncertain.

Counties rely primarily on health realignment funding (around $1.2 billion in 2026-27) to fund public health services as well as health care services for any individuals still participating in the indigent health care program. While counties are likely to face a significant increase in costs to grow their indigent health care programs, the structure of the AB 85 redirection of realignment funding affecting most counties does not consider to any extent an increase in costs. Therefore, given that available health realignment funding also supports counties’ public health responsibilities, counties are unlikely to have the resources required to meet the increased indigent health care demand without new, additional means of support. The counties estimate that county indigent programs will experience new enrollment of between 417,000 and 1.3 million with anticipated costs of $2 billion to $5.5 billion per year.

State programs. Some state programs, largely limited to certain “body parts” or medical conditions, remain options for individuals with qualifying incomes who are otherwise uninsured and have a specific medical need met by one of the programs. These include restricted-scope Medi-Cal, which pays for emergency and pregnancy care; Family Planning, Access, Care, and Treatment (Family PACT), which provides family planning and some reproductive health services; Every Woman Counts, which pays for breast and cervical cancer screening; the Breast and Cervical Cancer Treatment Program; and the Prostate Cancer Treatment Program. The AIDS Drug Assistance Program provides medications used in the treatment and suppression of HIV/AIDS and related opportunistic infections.

Health care provider programs. Certain health care providers directly provide some free or discounted care. Nonprofit hospitals must offer charity care and other community services as a condition of their exemption from income, property, and sales taxes. The facilities provide charity care to eligible uninsured and insured patients, with no expectation of payment. AB 2297 (Friedman), Chapter 511, Statutes of 2024, standardized some aspects of hospital charity care and discount programs and added other consumer protections. Starting January 1, 2025, those without insurance who have incomes below 400% of the FPL are eligible for some level of assistance. County-administered hospitals and public health systems, located in some urban centers in California, generally have a mission to provide access to health care services for all Californians, regardless of insurance status, immigration status, ability to pay, or other circumstances. However, financial assistance programs in these systems generally function similarly to those in nonprofit hospitals, and the level of generosity of the program varies by system. Federally Qualified Health Clinics, as part of federal requirements, must offer comprehensive primary care services on a sliding fee scale based on ability to pay.

Even providers who do offer free or discounted care have become inured to far less demand for such care in recent years and would have difficulty providing such care to millions more uninsured individuals. Pursuant to the federal Emergency Medical Treatment & Labor Act (EMTALA), all hospitals that participate in the Medicare program and operate emergency departments must provide screening and emergency stabilization services. However, EMTALA only requires services to be provided; the cost of services is not covered by the federal government, and EMTALA does not require hospitals to provide free or discounted emergency care. This requirement is often characterized as an unfunded mandate.

EMTALA. EMTALA was passed to address the problem of hospitals refusing to treat indigent, uninsured, or Medicaid patients, or "dumping" these patients by transferring them to county hospitals or other charity hospitals. Federal EMTALA obligates Medicare-participating hospitals that offer emergency services to provide a medical screening and treatment for an emergency medical condition, including active labor, regardless of an individual's ability to pay. State EMTALA imposes its obligation on any hospital that operates an ED, and has similar requirements to federal EMTALA. Hospitals are required to provide stabilizing treatment for patients with an emergency medical condition. A patient is "stabilized" when the patient’s medical condition is such that, within reasonable medical probability, no material deterioration of the patient's condition is likely to result from the release or transfer of the patient. If a hospital is unable to stabilize a patient within its capability, then a patient is required to be transferred to an appropriate facility with the necessary specialized treatment services. Once a patient is stabilized, if the patient needs post-stabilization care, the hospital will typically seek more information about the medical history of the patient, including whether the patient has insurance.

According to the Author

Under HR 1 California is bracing for a surge in uninsured residents, with counties estimating that indigent programs will experience new enrollment of between 417,000 and 1.3 million. When federal policies restrict eligibility, introduce intentional barriers to enrollment, or roll back coverage, people don't simply stop getting sick. Instead, they fall into our county safety nets to be the provider of last resort. The author argues that without a coordinated, statewide strategy to collect safety net program eligibility and contacts in a single platform to connect people to care, and understand the strain on local resources, our county health systems risk being overwhelmed, leaving our most marginalized communities without life-saving care. The author concludes this bill establishes a vital framework for transparency, access, and proactive planning to bridge the gap left by federal attack. We cannot wait for federal cuts to dismantle our health care safety net before we decide to act.

Arguments in Support

California Academy of Family Physicians (CAFP) supports this bill stating that stable, continuous health insurance coverage is critical to ensuring patients can receive timely preventive care, manage chronic conditions, and avoid unnecessary complications. However, when individuals lose coverage, they often face significant barriers to accessing care and may delay or forgo needed services. Safety-net programs play a vital role in filling these gaps, but information about available services can be difficult to find and varies widely by county. CAFP argues that this bill would improve transparency and help patients, providers, and community organizations better understand and navigate available resources.

Health Access California also supports this bill noting that recent changes to state and federal law will result in hundreds of thousands or even millions of Californians losing their health care coverage. Health Access contends that there is currently no state entity that compiles and displays for Californians relevant information about how to access county-provided health services. In fact, this is a role that many nonprofits end up playing, including Health Access on several occasions. This has involved direct outreach to each individual county to get updates on their programs, who they are serving and where individuals can find information; in many cases this information was not readily available online. Given the difficulty for advocates of tracking down this information, it is certainly not accessible to the consumers who most need resources. Health Access concludes that, though the patchwork of county indigent care programs should be a last resort safety net, it is imperative that consumers in need of care be able to readily access information on these local programs.

The Western Center on Law and Poverty supports this bill arguing that by requiring DHCS to establish a website to collect and display information about payment support resources available to help people access health care services, uninsured individuals will have access to critical information. They recommend that, in addition to the website, consideration should be given to providing information to individuals about resources available by phone or other means for those without access to the internet.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, the County Health Executives Association of California notes costs in the tens of thousands to hundreds of thousands of dollars per county, overwhelmingly related to staff time. Total cost for all counties could be in the low millions of dollars. If the Commission on State Mandates determines the provisions of this bill creates a new program or imposes a higher level of service for which the state must reimburse local costs, counties could claim reimbursement from the state (General Fund). 

Costs to DHCS of an unknown mount, potentially in the low hundreds of thousands of dollars to establish and maintain the website (General Fund).

VOTES

ASM HEALTH: 16-0-0

YES: Bonta, Chen, Addis, Aguiar-Curry, Ahrens, Caloza, Carrillo, Mark González, Johnson, Patel, Patterson, Rogers, Sanchez, Schiavo, Sharp-Collins, Stefani

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Hoover, Aguiar-Curry, Calderon, Caloza, Dixon, Fong, Mark González, Krell, Pacheco, Pellerin, Sharp-Collins, Solache, Ta, Tangipa

UPDATED

VERSION: April 16, 2026

CONSULTANT: Logan Hess / HEALTH / (916) 319-2097 FN: 0002975

Date of Hearing: May 6, 2026

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2368

Author:(Bonta) – As Amended Ver:April 16, 2026

Urgency: No State Mandated Local Program: Yes Reimbursable: Yes

SUMMARY:

This bill requires the Department of Health Care Services (DHCS) to establish a website where the public can access specified information on safety net health care services in the state. This bill also requires each county to prepare and submit to DHCS a plan to operate programs to provide health care to medically indigent individuals.

Specifically, this bill:

1. Requires DHCS, by July 1, 2027, to establish an internet website where the public can access information on safety-net health care services in the state.
2. Requires the website include information regarding the following:
   1. A person’s legally protected right to emergency medical care under state and federal law.
   2. Payment support resources, including coverage options, state programs, hospital charity care, and other assistance that is available to help people access health care services.
   3. Each county medically indigent health care program for uninsured individuals, including all eligibility requirements; cost of services; telephone number to reach the appropriate county program administrator; a hyperlink or Uniform Resource Locator (URL) for each county internet website related to safety-net services or medically indigent programs; and any other information or resources that will assist an individual seeking information about accessing medically indigent health care services.
3. Requires DHCS, in consultation with California State Association of Counties, local health officers, organizations advocating for consumers’ access to health care, and other entities with expertise in health care for medically indigent individuals, to review and update at least annually the information and resources on the website.
4. Requires each county, no later than January 1, 2028, to prepare and submit to DHCS a plan to operate programs to provide health care to medically indigent individuals.
5. Requires each county plan to include information on projected caseload and expenditure increases, and projected investment in workforce and services.
6. Requires DHCS to provide technical assistance upon the request of any county in developing its plan.

FISCAL EFFECT:

The County Health Executives Association of California notes costs in the tens of thousands to hundreds of thousands of dollars per county, overwhelmingly related to staff time. Total cost for all counties could be in the low millions of dollars. If the Commission on State Mandates determines the provisions of this bill creates a new program or imposes a higher level of service for which the state must reimburse local costs, counties could claim reimbursement from the state (General Fund). 

Costs to DHCS of an unknown mount, potentially in the low hundreds of thousands of dollars to establish and maintain the website (General Fund).

COMMENTS:

1. Purpose. According to the author:

Under HR 1 California is bracing for a surge in uninsured residents, with counties estimating that indigent programs will experience new enrollment of between 417,000 and 1.3 million. When federal policies restrict eligibility, introduce intentional barriers to enrollment, or roll back coverage, people don’t simply stop getting sick. Instead, they fall into our county safety nets to be the provider of last resort. Without a coordinated, statewide strategy to collect safety net program eligibility and contacts in a single platform to connect people to care, and understand the strain on local resources, our county health systems risk being overwhelmed, leaving our most marginalized communities without life-saving care. This bill establishes a vital framework for transparency, access, and proactive planning to bridge the gap left by federal attack. We cannot wait for federal cuts to dismantle our health care safety net before we decide to act.

1. Background. The LAO estimates that, due to H.R. 1 (Public Law 119-21), by 2030, nearly two million individuals could be disenrolled from Medi-Cal due to new eligibility requirements, effectively doubling the number of uninsured. Many of these individuals may have difficulty finding other sources of health coverage and may therefore seek care through county indigent care programs.

County indigent care programs generally directly provide or pay for a limited set of health care services. Case law establishes some basic responsibilities of counties for indigent care, but eligibility and service levels largely depend on county resources and priorities. Few counties provide care for Californians without legal immigration status. Programs are funded largely with state realignment funds provided to counties. Because demand for indigent care services declined over the last decade, commensurate with expanded Medi-Cal and Covered California eligibility, counties explain these programs now lack both the resources and the infrastructure to handle significantly increased demand.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 14, 2026

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2368

Author:(Bonta) – As Introduced Ver:February 19, 2026

SUBJECT: Indigent health care: information and planning.

SUMMARY: Requires the State Department of Health Care Services (DHCS), by July 1, 2027, to establish an internet website where the public can access specified information on safety-net health care services in the state. Requires each county, no later than January 1, 2028, to prepare and submit to DHCS a plan to operate programs to provide health care to medically indigent individuals, as necessary to meet additional need due to reduced access to health care coverage. Specifically, this bill:

1. Requires DHCS, by July 1, 2027, to establish an internet website where the public can access information on safety-net health care services in the state.
2. Requires the website include, at a minimum, all of the following:
   1. A person’s legally protected right to emergency medical care under state and federal law;
   2. Payment support resources, including coverage options, state programs, hospital charity care, and other assistance that is available to help people access health care services;
   3. Information about each county medically indigent health care program for uninsured individuals, including, but not limited to, all of the following:
      1. All eligibility requirements, including age, residency requirements, and income limits;
      2. The cost of services;
      3. The telephone number to reach the appropriate county program administrator; and,
      4. A hyperlink or Uniform Resource Locator (URL) for each county internet website related to safety-net services or medically indigent programs.
   4. Any other information or resources that will assist an individual seeking comprehensive and accurate information about accessing medically indigent health care services in the state.
3. Requires DHCS, in consultation with California State Association of Counties, local health officers, organizations advocating for consumers’ access to health care, and other entities with expertise in health care for medically indigent individuals, to review the information and resources on the website and update annually, at a minimum.
4. Requires each county, no later than January 1, 2028, to prepare and submit to DHCS a plan to operate programs to provide health care to medically indigent individuals, as necessary to meet additional need due to reduced access to health care coverage.
5. Requires the plan to include information on projected caseload and expenditure increases, projected investment, and assessment of funding sources.
6. Requires DHCS to provide technical assistance upon the request of any county in developing its plan.

EXISTING LAW:

1. Requires every county and every city and county to relieve and support all incompetent, poor, indigent persons, and those incapacitated by age, disease, or accident, lawfully resident therein, when such persons are not supported and relieved by their relatives or friends, by their own means, or by state hospitals or other state or private institutions. [Welfare and Institutions Code (WIC) § 17000]
2. Requires the board of supervisors of every county as a board, or by committee or by any person or society as it may authorize to investigate every application for relief from the funds of the county, to supervise by periodic visitation every person receiving that relief, to devise ways and means for bringing persons unable to maintain themselves to self-support, and to keep full and complete records of the investigation, supervision, relief, and rehabilitation, as specified. [WIC § 17006]
3. Requires emergency departments (EDs), under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) and also under similar provisions of state law (state EMTALA), to provide emergency screening and stabilization services without regard to the patient’s insurance status or ability to pay. Federal EMTALA imposes this requirement on any hospital that participates in Medicare. State EMTALA imposes this requirement on any hospital that operates an ED. [Title 42, United States Code § 1395dd and Health and Safety Code (HSC) § 1317]
4. Requires a hospital to provide a person without health coverage with a written estimate of the amount the hospital will require the person to pay for the health care services, procedures, and supplies that are reasonably expected to be provided to the person by the hospital, based upon an average length of stay and services provided for the person’s diagnosis. Allows the hospital to provide this estimate during normal business office hours. Requires the hospital to provide information about its financial assistance and charity care policies and contact information for a hospital employee or office from which the person may obtain further information about these policies. Requires the hospital to also provide the person with an application form for financial assistance or charity care. Excludes emergency services from these requirements. [HSC § 1339.585]
5. Requires each hospital to maintain an understandable written policy regarding discount payments for financially qualified patients as well as an understandable written charity care policy. Makes uninsured patients or patients with high medical costs who are at or below 400% of the federal poverty level (FPL) level eligible to apply for participation under a hospital’s charity care policy or discount payment policy. Requires the written policy regarding discount payments to include a statement that an emergency physician who provides emergency medical services in a hospital that provides emergency care is also required to provide discounts to uninsured patients or patients with high medical costs who are at or below 400% of FPL. [HSC § 127405]

FISCAL EFFECT: Unknown. This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, under HR 1 California is bracing for a surge in uninsured residents, with counties estimating that indigent programs will experience new enrollment of between 417,000 and 1.3 million. When federal policies restrict eligibility, introduce intentional barriers to enrollment, or roll back coverage, people don’t simply stop getting sick. Instead, they fall into our county safety nets to be the provider of last resort. The author argues that without a coordinated, statewide strategy to collect safety net program eligibility and contacts in a single platform to connect people to care, and understand the strain on local resources, our county health systems risk being overwhelmed, leaving our most marginalized communities without life-saving care. The author concludes this bill establishes a vital framework for transparency, access, and proactive planning to bridge the gap left by federal attack. We cannot wait for federal cuts to dismantle our health care safety net before we decide to act.
2. BACKGROUND.
   1. County indigent care programs. WIC Section 17000 was codified in 1965. It requires counties to “relieve and support all incompetent, poor, indigent persons, and those incapacitated by age, disease, or accident, lawfully resident therein, when such persons are not supported and relieved by their relatives or friends, by their own means, or by state hospitals or other state or private institutions.” However, this language by no means guarantees a meaningful health care safety net for millions of Californians who may lose coverage.

County indigent care programs generally do not offer “coverage,” they instead directly provide or pay for a limited set of health care services. Case law establishes some basic responsibilities of counties for indigent care, but eligibility and service levels largely depend on county resources and priorities. Few counties provide care for Californians without legal immigration status, and Section 17000 does not require it. Programs are funded largely with state realignment funds provided to counties. Because demand for indigent care services had declined over the last decade, commensurate with expanded Medi-Cal and Covered California eligibility, counties explain these programs now lack both the resources and the infrastructure to handle significantly increased demand.

According to the Legislative Analyst’s Office (LAO), court decisions have clarified that indigent health care programs are required to provide only the basic care necessary to prevent serious harm, pain, or infection. Programs are not required to provide specific benefits, so the minimum level of service required is significantly less than what is provided by other public programs (such as Medi-Cal). Counties are also able to set income-eligibility requirements based on subsistence living costs and an individual’s ability to pay. These requirements may take the form of cost-sharing arrangements with a sliding scale depending on an individual’s income.

Prior to the passage of the Patient Protection and Affordable Care Act (ACA), there were an estimated 850,000 enrolled in county indigent health care programs across the state. As the state has expanded Medi-Cal eligibility (to mostly childless adults and undocumented individuals), county indigent health care caseload has decreased, with counties estimating around 10,000 individuals currently enrolled. However, the number of enrollees per county can vary widely due to the broad county discretion over their programs. As enrollment in county indigent health programs declined as access to other health coverage for low-income individuals increased significantly, many counties have broadened their eligibility requirements to include additional participants and/or the scope of the benefits offered by their indigent care programs, as available resources allow. For example, some counties have chosen to accept individuals with unsatisfactory immigration status (UIS) or provide certain specialty care beyond the basic level of care required in statute.

• 1. County Medical Services Program (CMSP). According to the California Health Care Foundation’s (CHCF) recent issue brief, “Covering the Uninsured,” the CMSP continues to operate in 35 mostly small and rural counties, providing health coverage for uninsured low-income, indigent adults age 21–64 with incomes under 300% FPL who are not otherwise eligible for other publicly funded health care programs, notably Medi-Cal. A governing board sets policy for the program, and each county contracts with CMSP to provide services in that county. The CMSP does cover residents with UIS. The covered benefits, while broad, are not comprehensive (e.g., pregnancy-related services and long-term care are not included). Services are subject to prior authorization and medical necessity requirements, a share of cost, and some benefit limits. Interested people enroll through county health and human services departments. Starting in 2020, the CMSP added the Connect to Care program offering preventive health services and prescription drugs, with enrollment directly through participating community providers such as clinics and pharmacies.
  2. AB 85. In 2014, after implementation of the ACA, particularly the expansion of Medi-Cal to childless adults up to 138% of the FPL, the state made adjustments to realignment revenues supporting county indigent programs to account for the newly expanded Medi-Cal population that would no longer need to be covered at the county level. AB 85 (Committee on Budget), Chapter 24, Statutes of 2013, redirected realignment funds according to various formulas in different counties. For the thirty-four largely rural counties participating in CMSP, AB 85 required 60% of health realignment funding that would have been received to be redirected to the state. The 12 public hospital counties and the remaining 12 counties were able to choose whether to have 60% of realignment redirected, or to use a formula-based approach that takes into account a county’s cost and revenue experience. All but four of those counties chose a formula-based approach.
  3. HR 1 impacts. The LAO estimates that by 2030, nearly 2 million individuals could be disenrolled from Medi-Cal due to new eligibility requirements (effectively doubling the number of uninsured individuals). Many of these individuals may have difficulty finding other sources of health coverage and may therefore seek care through county indigent care programs. The LAO estimates anywhere between 20% and 50% (400,000 to 1 million) of these individuals may enroll in county indigent health care programs, though these estimates are highly uncertain.

Counties rely primarily on health realignment funding (around $1.2 billion in 2026-27) to fund public health services as well as health care services for any individuals still participating in the indigent health care program. While counties are likely to face

a significant increase in costs to grow their indigent health care programs, the structure of the AB 85 redirection of realignment funding affecting most counties does not consider to any extent an increase in costs. Therefore, given that available health realignment funding also supports counties’ public health responsibilities, counties are unlikely to have the resources required to meet the increased indigent health care demand without new, additional means of support. The counties estimate that county indigent programs will experience new enrollment of between 417,000 and 1.3 million with anticipated costs of $2 billion to $5.5 billion per year.

• 1. State programs. Some state programs, largely limited to certain “body parts” or medical conditions, remain options for individuals with qualifying incomes who are otherwise uninsured and have a specific medical need met by one of the programs. These include restricted-scope Medi-Cal, which pays for emergency and pregnancy care; Family Planning, Access, Care, and Treatment (Family PACT), which provides family planning and some reproductive health services; Every Woman Counts, which pays for breast and cervical cancer screening; the Breast and Cervical Cancer Treatment Program; and the Prostate Cancer Treatment Program. The AIDS Drug Assistance Program provides medications used in the treatment and suppression of HIV/AIDS and related opportunistic infections.
  2. Health care provider programs. Certain health care providers directly provide some free or discounted care. Nonprofit hospitals must offer charity care and other community services as a condition of their exemption from income, property, and sales taxes. The facilities provide charity care to eligible uninsured and insured patients, with no expectation of payment. AB 2297 (Friedman), Chapter 511, Statutes of 2024, standardized some aspects of hospital charity care and discount programs and added other consumer protections. Starting January 1, 2025, those without insurance who have incomes below 400% of the FPL are eligible for some level of assistance. County-administered hospitals and public health systems, located in some urban centers in California, generally have a mission to provide access to health care services for all Californians, regardless of insurance status, immigration status, ability to pay, or other circumstances. However, financial assistance programs in these systems generally function similarly to those in nonprofit hospitals, and the level of generosity of the program varies by system. Federally Qualified Health Clinics, as part of federal requirements, must offer comprehensive primary care services on a sliding fee scale based on ability to pay.

Even providers who do offer free or discounted care have become inured to far less demand for such care in recent years and would have difficulty providing such care to millions more uninsured individuals. Pursuant to the federal EMTALA, all hospitals that participate in the Medicare program and operate emergency departments must provide screening and emergency stabilization services. However, EMTALA only requires services to be provided; the cost of services is not covered by the federal government, and EMTALA does not require hospitals to provide free or discounted emergency care. This requirement is often characterized as an unfunded mandate.

• 1. EMTALA. EMTALA was passed to address the problem of hospitals refusing to treat indigent, uninsured, or Medicaid patients, or “dumping” these patients by transferring them to county hospitals or other charity hospitals. Federal EMTALA obligates Medicare-participating hospitals that offer emergency services to provide a medical screening and treatment for an emergency medical condition, including active labor, regardless of an individual's ability to pay. State EMTALA imposes its obligation on any hospital that operates an ED, and has similar requirements to federal EMTALA. Hospitals are required to provide stabilizing treatment for patients with an emergency medical condition. A patient is “stabilized” when the patient’s medical condition is such that, within reasonable medical probability, no material deterioration of the patient’s condition is likely to result from the release or transfer of the patient. If a hospital is unable to stabilize a patient within its capability, then a patient is required to be transferred to an appropriate facility with the necessary specialized treatment services. Once a patient is stabilized, if the patient needs post-stabilization care, the hospital will typically seek more information about the medical history of the patient, including whether the patient has insurance.

1. SUPPORT. California Academy of Family Physicians (CAFP) supports this bill stating that stable, continuous health insurance coverage is critical to ensuring patients can receive timely preventive care, manage chronic conditions, and avoid unnecessary complications. However, when individuals lose coverage, they often face significant barriers to accessing care and may delay or forgo needed services. Safety-net programs play a vital role in filling these gaps, but information about available services can be difficult to find and varies widely by county. CAFP argues that this bill would improve transparency and help patients, providers, and community organizations better understand and navigate available resources.

Health Access California also supports this bill noting that recent changes to state and federal law will result in hundreds of thousands or even millions of Californians losing their health care coverage. Health Access contends that there is currently no state entity that compiles and displays for Californians relevant information about how to access county-provided health services. In fact, this is a role that many nonprofits end up playing, including Health Access on several occasions. This has involved direct outreach to each individual county to get updates on their programs, who they are serving and where individuals can find information; in many cases this information was not readily available online. Given the difficulty for advocates of tracking down this information, it is certainly not accessible to the consumers who most need resources. Health Access concludes that, though the patchwork of county indigent care programs should be a last resort safety net, it is imperative that consumers in need of care be able to readily access information on these local programs.

The Western Center on Law and Poverty supports this bill arguing that by requiring DHCS to establish a website to collect and display information about payment support resources available to help people access health care services, uninsured individuals will have access to critical information. They recommend that, in addition to the website, consideration should be given to providing information to individuals about resources available by phone or other means for those without access to the internet.

1. PREVIOUS LEGISLATION.
   1. SB 1142 (Caballero), Chapter 556, Statutes of 2022, requires the California Health and Human Services Agency, or a designated entity, to establish a website where the public can access specified information about abortion services.
   2. AB 85 (Committee on Budget), Chapter 24, Statutes of 2013, revised realignment formulas, redirecting a portion of the health realignment revenues that counties had historically spent on indigent care to offset state General Fund costs for CalWORKs grants.
2. COMMITTEE AMENDMENTS. The committee may wish to strike Paragraph (4) of subdivision (b) in Section 2.

REGISTERED SUPPORT / OPPOSITION:

Support

California Academy of Family Physicians

Health Access California

Western Center on Law & Poverty

Opposition

None on file

Analysis Prepared by: Logan Hess / HEALTH / (916) 319-2097