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Counties Warn: Decade‑old Realignment and AB 85 Changes Left Indigent Care Fragile
Summary
County officials told legislators that 1991 realignment and AB 85 redirections left local indigent programs underfunded and administratively uneven; many counties lack clinics or hospitals and cannot scale quickly without state help and a technical AB 85 correction.
County witnesses and associations told the panel that structural changes over decades — 1991 realignment, AB 85 funding redirections and Medi‑Cal expansion — left county indigent care programs diminished or dormant and that restoring capacity will require statutory fixes and state partnership.
The LAO detailed the history: WIC 17000 established county responsibility for basic indigent care; 1991 realignment moved responsibilities and dedicated revenue streams; AB 85 later redirected portions of those revenues when ACA reduced county caseloads. Mark Newton (LAO) and county witnesses said those past decisions assumed reduced indigent caseloads and are now misaligned with the expected demand increase.
County officials emphasized that many 'article 13' counties do not operate public hospitals or clinics and rely on contracts with community providers. Tulare and San Diego described different starting points: some counties can scale via pooled models (CMSP), others cannot. County leaders asked for a modest AB 85 technical correction to clarify petition authority to change methodology and for flexible funding that recognizes county differences.
Why it matters: the legal and funding framework determines which local authorities can respond, how funds flow and whether counties can lawfully use redirected realignment dollars to cover indigent care.
