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Expanding Health Coverage in California: County Jails as Enrollment Sites

By Shannon McConville, Mia Bird

In 2014, the first year of Affordable Care Act (ACA) implementation, the number of Californians with health insurance increased substantially. However, millions of state residents continue to lack comprehensive health coverage, and those who remain uninsured are likely more difficult to enroll through traditional strategies.

In this report, we find that uninsured rates are highest for young men and for those with low levels of education, income, and employment. The prevalence of these same characteristics among correctional populations suggests that the justice system—and, in particular, county jails—may offer points of contact for many uninsured individuals who would otherwise be hard to reach.

Outreach and enrollment efforts aimed at local jail populations are set within the policy context of California’s 2011 Public Safety Realignment, which created incentives and resources for local corrections agencies to improve reentry outcomes. With expansions in access to health insurance coverage under the ACA, nearly all counties are establishing programs to provide enrollment assistance to jail inmates as part of a more comprehensive reentry strategy. But resources and capacity are limited, so it is important to identify effective models to maximize the potential of county correctional systems as sites of insurance enrollment.

Report

Low-Income Students and School Meal Programs in California

By Caroline Danielson

School nutrition programs help improve nutrition among vulnerable children. In so doing, they help build a better future for these children and the state. Now that California is implementing the Local Control Funding Formula (LCFF), there is additional reason to make sure all students who are eligible for free or low-cost meals enroll in these programs. Along with English Learners and foster youth, low-income students—in other words, students who are eligible for free and reduced-price meals—are targeted for additional funds under the LCFF. This renewed focus on enrollment could also prompt further consideration of participation in school nutrition programs.

This report looks at factors that might be linked to variations in student enrollment and participation in free or reduced-price meals. Not surprisingly, we find that districts with higher poverty rates identify higher levels of eligibility than wealthier districts. Low-income high school students appear to be enrolled at levels comparable to younger students, but students in elementary school districts are much more likely to participate in lunch programs than students in other types of districts. We also find that schools in districts with higher shares of foreign-born residents have modestly lower participation levels (but not identification of low-income students). Finally, we find evidence that schools with smaller enrollments are more successful than larger schools at identifying and serving low-income students.

One way to further the goal of full enrollment among low-income students is to cut the large share of low-income students who must submit applications for free or reduced-price meals. Achieving this objective is arguably an important part of a larger state effort to integrate social safety net programs and services.

Report

Child Poverty and the Social Safety Net in California

By Caroline Danielson, Sarah Bohn

Because economic hardship is associated with a host of adverse outcomes, particularly for children, policies that can give children a better start in life are especially important. This report focuses on measuring material hardship among children across the state. Using the California Poverty Measure—which accounts for both family earnings and safety net resources and adjusts for work expenses and housing costs—we find that one-quarter of California’s children are in poverty. An additional 26 percent of children live in households that are "near poor,” or somewhat above what is often referred to as the poverty line. In short, about half of California’s children are poor or near-poor. Poverty rates, earnings, and the role of safety net resources all vary by region. But most poor children live in "working poor” families, with one or more working adults. And, without resources from the social safety net—which includes the federal Earned Income Tax Credit, CalFresh (California’s food stamp program), CalWORKs (California’s welfare program), and housing subsidies—there would be far more children in poverty throughout California.

Report

Health Care for California’s Jail Population

By Shannon McConville, Mia Bird

The Affordable Care Act (ACA) has created a new opportunity for California to reach and enroll a medically vulnerable population—the jail population—in health insurance coverage. While inmates receive health care services from county jail systems while incarcerated, few have coverage after they are released from custody. Expansion of the state’s Medicaid program (Medi-Cal) under the ACA has extended insurance eligibility to much of the currently uninsured jail population. As a complement to the ACA, California recently signed into law Assembly Bill 720 (AB 720), which facilitates the use of jails as sites of health insurance enrollment. Increasing enrollment levels for the jail population holds the potential to reduce corrections costs, as well as improve public health and safety.

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