For decades, California's 58 counties have been core providers of health care services and public health programs in local communities. Under state law, counties are the primary providers of health care for low-income individuals who have no other form of health coverage. Counties organize and oversee local mental health and substance use disorder programs, primarily for Medi-Cal and uninsured patients. County public health departments operate public health laboratories and administer a range of disease prevention and health promotion programs.
To administer and support this wide array of health programs and services, counties must navigate a complex set of federal, state, and local funding streams and requirements. One significant, complicating aspect of the state-county partnership on health has been a back-and-forth shift in responsibility for program administration, funding, and decisionmaking between the state and counties.
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