Last year, the County of San Luis Obispo faced one of the most significant initiatives ever to affect the local health care system – The Patient Protection and Affordable Care Act (ACA).

The County was tasked with implementing the ACA, and multiple departments worked together to better understand the law, how it should be implemented and the overall effects it would have on local residents.

Thousands Receive Health Care Coverage

Watch: Department of Social Services Discusses Local Affordable Care Act Implementation (August 19, 2014)

As a result of the passage of the ACA in March 2010, thousands of uninsured San Luis Obispo County residents became eligible for coverage under either an expanded Medi-Cal program or under new low-cost or subsidized insurance programs offered by Covered California—the State’s version of the federally-required health exchange.

Under the ACA, the County of San Luis Obispo Department of Social Services (DSS) was responsible for determining the eligibility of local residents applying for Medi-Cal coverage through Covered California.

With an additional 24 staff members and state-allocated funding of about $2.2 million, DSS exceeded California Department of Health Care Services expectations. County staff processed 44 percent more Medi-Cal applications than expected, for a total of 13,176 applications representing 18,424 County residents.

The County also exceeded Covered California enrollment projections by at least 50 percent, with a total of 12,256 residents applying for coverage.

“We understand that the Affordable Care Act is a controversial topic, but we don’t have the luxury of having an opinion; we are only charged with implementing it,” said Director of Social Services Lee Collins. “Our staff has done an amazing job at that, and we’ll continue to work with other County departments to meet the health care needs of local residents.”

By August 2014, one out of nine SLO County residents, or more than 30,000 people had applied for coverage under the ACA. County staff was responsible for processing the majority of those applications.

Prior to January 2014, an estimated 43,000 County residents, or near 16 percent, lacked health insurance. Reasons for the lack of health insurance included the cost being unaffordable, ineligibility due to a pre-existing health condition or undocumented immigration status, or general indifference.

Through the coverage mandate under the ACA, health insurance became available and required for the vast majority of those previously uninsured. More than 90 percent of Covered California enrollees from SLO County received federal premium subsidies (available to households with incomes less than 400 percent of the federal poverty limit), and previously uninsured residents could no longer be denied coverage due to a pre-existing condition, among other important changes.

Assisting Special Populations

“County staff processed 44 percent more MediCal applications than expected, for a total of 13,176 applications representing 18,424 County residents.”

In addition to the thousands of people who applied for health care coverage in SLO County, special populations are also transitioning to Medi-Cal thanks to new eligibility requirements. County staff continues to identify and work with these special populations to help the transition move more smoothly.

As of August 2014, 500 County Jail inmates and 2,800 indigent County residents – about 240 of whom received cash assistance or General Assistance each month – were eligible and applied for Medi-Cal with the help of County staff. Watch the full August 2014 staff report on the status of ACA implementation.

In September 2014, the County’s Health Agency also reported that the ACA affected the availability of health services in two important ways: (1) low-income childless adults not previously eligible for Medi-Cal were now eligible, and (2) behavioral health services were now mandated benefits for people living with mental illness and/or substance use disorders.

These changes presented significant implications for many of the County Health Agency’s health care service delivery programs, including its Medically Indigent Services Programs, Mental Health Services, and Substance Use Disorder Services. To address these issues, County Health Agency staff rallied and worked with other departments and stakeholders to ensure that the medical needs of our community continued to be met.

As the County moves forward and continues to implement and be impacted by the ACA, County staff will continue to provide status reports and updates to the Board of Supervisors and the public, as well as increase its own understanding of new benefits available and previous gaps that have been addressed to implement the law.

Read the full September 2014 staff report on the effects of the ACA on health services in San Luis Obispo County.