A PDF of “Understanding County Health Services in California: A Brief Overview” is available at right under Documents & Resources.

Introduction

Counties in California have been providing health services in California for almost 150 years. Since 1933, California law (Welfare and Institutions Code Section 17000) has required counties to provide relief to the poor, including health care services and general assistance. County residents receive these services, regardless of whether they live in the unincorporated area of the county or within city limits.

Summary of County Health Services³

The county health department is also the cities’ health department. With the exception of the cities of Berkeley, Long Beach, and Pasadena which operate separate health departments for residents, county health services cover residents in both the unincorporated and incorporated areas of the county – that is, within the county and city limits.

Administrative Structure

The county health system is usually an agency or department within the county and is administered by an Administrative Director who is appointed by either the County Administrative Officer and/or the Board of Supervisors. The Board of Supervisors also appoints a Public Health Officer, who is a physician, and who serves as the chief medical officer for the county on public health issues. The organizational structure and programs offered vary from county to county.

The discussion below summarizes the responsibilities and services provided by county health departments.

Alcohol-Drug — Assures necessary substance abuse services are available to the public through a network of public operated and private contracted providers. Services typically include inpatient and outpatient care, residential recovery, detoxification, information, education, prevention, and early intervention.

Detention Facilities — Assures that necessary medical, dental, psychiatric, and substance abuse services are provided to adult and juvenile persons incarcerated in county facilities.

Environmental Health — Provides all health related approvals and permits relating to land development (well water permits, septic permits, and land use permits), consumer protection (food facility inspections/permits, public pools, small water systems, solid waste, and food borne illness investigation), and hazardous materials [underground storage tanks, medical waste, Proposition 65 reporting (safe drink water enforcement), chemical spills, and incident response].

Emergency Medical Services (EMS) — If designated as the local Emergency Medical Services agency, responsibilities involve ambulance permitting and monitoring, Emergency Medical Technician certification, emergency medical dispatch approvals, and disaster planning.

Hospitals — Currently 13 counties operate hospitals. Most of these hospitals are full service teaching hospitals affiliated with university medical schools. Services vary slightly from hospital to hospital but generally include medical, surgical, emergency, trauma, outpatient, and a wide variety of specialty services. The following counties operate hospitals.

• Alameda
• Contra Costa
• Kern
• Los Angeles
• Modoc (until 2011)
• Monterey
• Riverside
• San Bernardino
• San Francisco
• San Joaquin
• San Mateo
• Santa Clara
• Ventura

Indigent Medical Care — Provides medical care to indigent persons, including Medically Indigent Adults, in a variety of ways including operating a county hospital and/or primary care clinics, or using a wide variety of contracts with providers of care to fulfill their responsibilities. Indigent persons are uninsured, low–income adults who have no other source of health care and are not categorically linked to other public health insurance programs.

Medically Indigent Adults (MIA) — Medically Indigent Adults are those individuals age 21-64 who do not qualify for Medi-Cal. Generally, childless adults are excluded from Medi-Cal. These individuals typically earn too little to purchase either health care or health insurance.

The twenty-four most populous counties administer their own programs for Medically Indigent Adults. Each county sets its own eligibility standards, services, and provider networks.

The other thirty-four counties, primarily rural counties, pool their resources to provide indigent health services; the County Medical Services Program (CMSP) administers this indigent health program.

Mental Health — Provides a wide range of psychiatric services to the public either directly or by contract with private providers. Services typically include acute inpatient care for persons who are a danger to themselves, others, or are gravely disabled, long- term care in facilities that treat mental disease, local crisis services, day treatment, and outpatient care.

Public Health — Services include prevention, early intervention, education, and treatment through a wide range of specific programs and services. These typically include:

• Adult health screening;
• HIV/AIDS testing and counseling;
• Communicable and infectious disease control;
• Immunizations; family planning;
• Children’s services, including the Child Health and Disability Prevention program, physical exams, medical, nutrition, etc.;
• Sexually transmitted diseases;
• Home nursing visits; tuberculosis;
• Women, Infants and Children (WIC) nutritional services; and vital statistics registration involving birth/death certificates and burial permits.

Normally an onsite laboratory performs all public health related tests required by the nursing functions of the agency in addition to testing for rabies, water, food, Lyme disease, parasites, bacteria, and microorganisms.

Other Useful Resources for Understanding County Health Services

Several other resources offer information about how counties provide health services to Californians.

• California State Association of Counties (www.counties.org)
  
  (See especially the “What Counties Do” section under the California’s Counties tab.) The California State Association of Counties’ website includes information about county health services and links to information about other county services.

• The Crucial Role Counties Play in the Health of Californians
  
  “The Crucial Role Counties Play in the Health of Californians”⁴ provides in depth information about the health and health-related services counties provide, including information about how the services are funded. It also discusses challenges faced by counties in providing these services. While the document was produced in 2004, it remains relevant.

¹“California Guide to Finding Health Insurance Coverage” was developed by the Cover the Uninsured project (www.covertheuninsured.org). Cover the Uninsured is a project of the Robert Wood Johnson Foundation.

²“Finding Health Care Coverage in California” was funded by the Anthem Blue Cross Foundation, the Foundation for Health Care Coverage Education and the California Association of Health Underwriters.

³The information is adapted from information provided by the California State Association of Counties (www.counties.org).

⁴“The Crucial Role Counties Play in the Health of Californians” is authored by Deborah Reidy Kelch, M.P.P.A. for the California Health Care Foundation (www.chcf.org).