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Toward a New Understanding: The California Statewide Study of People Experiencing Homelessness

June 22, 2023

This report outlines the largest representative study of homelessness in the United States since the mid-1990s. The study provides a comprehensive look at the causes and consequences of homelessness in California and recommends policy changes to shape programs in response.Designed to be representative of all adults 18 years and older experiencing homelessness in California, CASPEH includes nearly 3,200 administered questionnaires and 365 in-depth interviews with adults experiencing homelessness in eight regions of the state, representing urban, rural, and suburban areas. Interviews were conducted in English and Spanish, with interpreters for other languages. In partnership with a wide array of community stakeholders, the UCSF BHHI team collected data between October 2021 and November 2022. CASPEH was funded by UCSF BHHI, the California Health Care Foundation, and Blue Shield of California Foundation.

Understanding Training and Workforce Pathways to Develop and Retain Black Maternal Health Clinicians in California

May 16, 2023

Despite evidence that greater diversity in health professions increases quality of care, the maternal health field has made little progress on increasing and sustaining the number of Black maternal health care workers. In this study, Urban researchers examine opportunities for and barriers to increasing the workforce of Black obstetrician/gynecologists (OB/GYNs), labor and delivery (L&D) nurses, and midwives, especially in light of the ongoing US maternal health crisis. Through interviews with Black maternal health clinicians and training program staff, we recommend actions that federal and state policymakers, leaders at higher education and health system institutions, and philanthropies can take to address structural barriers to entering and staying within the field and to support a thriving workforce.

Health Care Access among California’s Farmworkers

April 25, 2022

Recent federal and state policies may have improved access to health insurance for farmworkers, who are important contributors to California's economy and an essential link in the food supply chain. The Affordable Care Act (ACA) included an expansion of Medi-Cal to most low-income adults, and a mandate requiring companies with at least 50 workers to offer employer health insurance. California also expanded Medi-Cal to young undocumented immigrants, and will soon extend it to older individuals. This report investigates whether these policies coincided with better insurance coverage or reduced barriers to health care for immigrant farmworkers.Farmworkers are aging and more likely to settle in the US with family; thus, their health care needs—and those of their families and children—will likely grow. Cost or lack of insurance are the most salient barriers to health care for farmworkers; few farmworkers note barriers related to immigration status, although being undocumented is a strong predictor of lacking health insurance. Many documented farmworkers have enrolled in Medi-Cal following the ACA expansion, which has increased coverage rates and lowered cost and insurance barriers to health care. Undocumented farmworkers have not fared as well in these areas. Employer health insurance coverage for farmworkers did not change detectably with the rollout of the ACA employer mandate, regardless of a farmworker's documentation status or whether the worker was a direct hire versus a contractor. These findings take on special importance during the coronavirus pandemic. Farmworkers have continued to work during the public health emergency. Yet with California's high cost of housing, many farmworkers live in crowded conditions, making it difficult to remain socially distant from other household members. Although emergency Medi-Cal covers COVID-19 treatment regardless of immigration status, long COVID and resulting disability may threaten farmworkers' health and livelihoods.

Investing in Primary Care: Why It Matters for Californians with Commercial Coverage

April 19, 2022

Decades of research have shown that increased investments in primary care lead to higher-quality and more equitable care as well as lower costs. However, there were few data on the level of primary care investment specifically in the California health care market. This first-of-its-kind study, Investing in Primary Care: Why It Matters for Californians with Commercial Coverage, measures primary care spending, as a proportion of overall spending, among eight health plans and their product offerings, covering 80% of commercially insured adults in California (13.9 million). The study also took a deeper look at the primary care spending of 180 separate provider organizations, comprising 8.5 million adults enrolled in HMO plans, or nearly half of California's commercially insured adults.To measure the impact of primary care investment on care quality, researchers compared provider organizations on measures including the share of members who received recommended breast cancer, cervical cancer, and colorectal cancer screenings; received appropriate medications; and who had their diabetes care goals met. 

Connected Care Accelerator Innovation Learning Collaborative Final Evaluation Report

January 31, 2022

The Connected Care Accelerator Innovation Learning Collaborative Final Evaluation Report looks at the health centers participating in the Innovation Learning Collaborative during the pandemic. Authored by the Center for Community Health and Evaluation (CCHE), part of Kaiser Permanente Washington Health Research Institute, the report assesses changes in the health centers' capacity to implement virtual care, the experience of health care staff in delivering telehealth, and the impact of the collaborative. The report draws on clinical utilization data from February 2019 to February 2021, including visits and unique patients by modality (clinic, phone, in-person) and interviews with health center teams in fall 2020 and spring 2021.

The Medi-Cal Maze: Why Many Eligible Californians Don’t Enroll

September 13, 2021

Millions of Californians have gained health coverage through Medi-Cal, yet many eligible for the program remain uninsured. CHCF commissioned qualitative research to better understand what prevents eligible Californians from enrolling and to identify ways California can make Medi-Cal even more accessible to the population it is designed to serve. Through virtual focus groups and in-depth interviews with 91 Californians, the research team explored the knowledge, attitudes, and enrollment experiences of people who are likely eligible for Medi-Cal yet remain uninsured.

Three in 10 Adults in California Immigrant Families with Low Incomes Avoided Safety Net Programs in 2020

July 29, 2021

Many immigrant families have avoided safety net and pandemic relief programs in recent years over concerns that their participation would have adverse immigration consequences. These chilling effects on program participation occurred in the context of a restrictive immigration policy environment under the Trump administration, including the expansion of the "public charge" rule. Though the Biden administration has reverted to prior guidance on the public charge rule and reversed many other immigration policy changes, chilling effects may continue to deter adults in immigrant families from seeking safety net supports for which they or their children are eligible.This study draws on Well-Being and Basic Needs Survey data collected in December 2020 and interviews conducted with adults in immigrant families and people who work at organizations that connect immigrant families to health, nutrition, and other support programs in California. The interviews were conducted between March and May 2021, in the early months of the Biden administration, offering unique insights as policy priorities were shifting.

Health Coverage and Care for Undocumented Immigrants: An Update

June 23, 2021

California policymakers continue to weigh strategies for making health insurance universal and health care accessible to all—including for undocumented immigrant residents. The state expanded Medi-Cal to undocumented children and young adults using mostly state funds, and budget negotiations are underway to expand coverage to older undocumented adults. While coverage for all undocumented immigrants has been on the legislative agenda for several years, COVID-19 has underscored how gaps in health insurance coverage for immigrants, fear and avoidance of health care systems, and lack of access to vaccines can have consequences for entire communities.This report updates PPIC's past work on health care and insurance coverage for undocumented immigrants, from presenting updated uninsured rates among immigrant groups to unpacking systematic differences in health care access by documentation status. We also examine aspects of how children in mixed-status families—where at least one member is undocumented—engage with the health care system. 

Maternal Mental Health: State of the State Report in California and Beyond, a Follow-up Report

December 2, 2019

This report is a follow up to the report issued by the California Task Force on Maternal Mental Health Care in April 2017 A Report from the California Task Force on the Status of Maternal Mental Health Care: A Strategic Plan. That report contained a detailed overview of maternal mental health, and a state strategic plan, as well as specific recommendations for state and national stakeholder groups.This report provides an update on the implementation of the strategic plan as well as other efforts which have occurred in the state or nation to advance maternal mental health screening, diagnosis, and treatment. It seeks to summarize California's gaps in MMH care, identify strategies for improvement, and provide a clear call-to-action and framework for coordinating stakeholder responsibilities.The original report is available through 2020 Mom at:

Evaluators as Conduits and Supports for Foundation Learning

March 1, 2019

Evaluators play a critical role in supporting philanthropic learning, programming, and strategy, but evaluation and learning in philanthropy is often limited in ways that impede deeper resonance and impact. Most philanthropic evaluation is focused on the needs of individual foundations, knowledge sharing with the broader field is limited, and foundations struggle to integrate evaluation and learning as a management tool. This article makes the case that evaluators and funders can do more to build the collective capacity of evaluators working in philanthropy in order to enhance their contributions to community change. This article also examines the ways that evaluation in philanthropy is evolving, lays out root causes of its limitations, and looks at emerging tools, techniques, and lessons that showcase new ways evaluators and funders are working together to strengthen practice.

Towards Universal Health Coverage: California Policy Options for Improving Individual Market Affordability and Enrollment

March 5, 2018

California has made historic progress under the Affordable Care Act (ACA) by cutting the uninsurance rate by more than half, resulting in approximately 93% of Californians now having health insurance. Health coverage affordability has improved for many, especially for those who became newly eligible for Medi-Cal or subsidized coverage through Covered California. For those who purchase coverage individually, the ACA has not only provided financial assistance to help eligible low- and middle-income individuals afford premiums and out-of-pocket costs, but has also provided crucial protections to individual market enrollees of all income levels. These protections include requiring insurers to offer insurance to all without charging higher premiums for those with pre-existing conditions, setting a floor for the share of costs that insurers cover, and establishing a ceiling on enrollees' out-of-pocket costs. However, many Californians continue to face difficulties in affording premium and out-of-pocket costs. Affordability challenges can deter enrollment in and retention of coverage, cause financial difficulties for those struggling to pay premiums or medical bills, and decrease access to care. In this report, we focus specifically on the affordability challenges for the 2.3 million Californians who purchase private insurance individually and for many of the 1.2 million Californians who are eligible to purchase insurance through Covered California but remain uninsured. We also explore state policy options for improving affordability of individual market premiums and out-of-pocket costs, and consequently helping move the state closer to universal coverage. This set of policy options was developed based on analysis of the available evidence on affordability concerns in California's individual market, as well as on a review of policies used by other states and localities to improve affordability.

California’s Ambulatory Surgery Centers: A Black Box of Care

February 1, 2018

Many surgeries are performed in freestanding, or "same-day," ambulatory surgery centers (ASCs). The number of freestanding ASCs in California has increased dramatically over the past 11 years. However, due to a legal decision that removed reporting requirements for ASCs in the state, little is known about the volume of procedures, type of procedures, and financial operation of the vast majority of these facilities. looks at the most recent data on the supply, use, quality, and finances of freestanding ASCs in California, as well as trends from 2005 to 2016.