California is the largest state by population size and the third largest state by land area in the nation.[1] [2] California is bordered by Oregon to the north, Mexico to the south, Nevada and Arizona to the east, and the Pacific Ocean to the west. It is divided into 58 counties ranging in size from under 50 square miles in San Francisco to over 20,000 square miles in San Bernardino.[3] These 58 counties and an additional three designated cities, City of Berkeley, City of Long Beach, and City of Pasadena, make up the 61 local health jurisdictions in California.
An estimated 39.6 million people reside in California.[4] The state’s population is projected to increase to 42.3 million by 2025 and 51.0 million by 2060.[5] By 2025, more than one million residents are projected to live in each of the following 10 counties: Alameda, Contra Costa, Fresno, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, and Santa Clara.[6]
There is no single racial or ethnic group forming a majority of the state’s population. The largest racial or ethnic groups are Hispanic (40%), White (37%), and Asian (14%). The Black population comprises about 6% of the overall population. By 2060, the multiracial population is expected to increase by 71%. The Hispanic population is expected to increase by 43%, while the Asian population is expected to increase by 31%. The Native Hawaiian-Pacific Islander population and the American Indian-Alaska Native
population are both expected to increase about 26%. The Black population is expected to increase by 20%.[7]
California’s diversity is compounded by multiple subgroups within a single racial or ethnic group. For instance, the state has the largest Asian population in the nation with 5.5 million, followed by New York with 1.7 million.[8] The Asian population includes, but is not limited to, residents identified as Chinese, Filipino, or Vietnamese. There are more than 20 Asian subgroups, such as Pakistani and Sri Lankan.[9] The racial or ethnic diversity is further compounded by their concentrations across the state. For instance, the largest number of residents identified as Mexican reside in Los Angeles County, whereas the largest number of residents identified as Salvadoran reside in San Bernardino County.[10]
California is home to more than 10 million immigrants. The largest numbers of immigrants come from Mexico followed by China, the Philippines, and Vietnam. Foreign-born residents account for over 30% of the population in seven counties, such as Santa Clara and Orange.[11]
An estimated 2.4 to 2.6 million undocumented immigrants reside in the state. They make up nearly 25% of all undocumented immigrants in the nation. The size of this population ranges from about 2,000 in Shasta County to 9,000 in San Luis Obispo County and 248,000 in Orange County.[12]
Approximately 16.5 million residents aged 5 to 64 years (representing nearly 42% of the total population) speak a language other than English at home.[13] Based on a special tabulation by the U.S. Census, more than 200 languages are spoken at home in California. These languages vary widely from Spanish and Korean to Burmese and Serbian.[14] About 3.5 million – or 21% of all residents speaking a foreign language – do not speak English well or not at all. For instance, about 4% of children from Spanish-speaking households do not speak English well or not at all compared with 14% of adults in these households. On the other hand, about 6% of children from Asian- and Pacific-Islander-speaking households do not speak English well or not at all compared with 19% of adults in these households.[15]
The California economy is the largest in the country accounting for $2.7 trillion dollars or 14% of the nation’s total gross domestic product. The state’s economic output in 2016 was the fifth largest in the world after United States, China, Japan, and Germany.[16] It has grown by an average of nearly 3% per year since 2010, based on the value of a dollar in 2009.[17] The finance industry accounts for 22% of the state’s economic output. This is followed by the professional and business services industry with 13% and the government industry with 12%. The education industry accounts for 7% of the gross domestic product.[18]
Although the state’s economy is large, there continues to be great disparities in wealth distribution between households.[19]
An estimated 5.8 million residents in California live below the federal poverty level. This represents 15% of the state’s population. However, several population subgroups experience a higher proportion of poverty. For instance, about 21% of the population living in poverty are children under 18 years of age. A greater proportion of residents identified as Black (23%), American Indian-Alaska Native (22%), or Hispanic (21%) live in poverty than residents identified Asian (11%) or White (14%).[20] At the county level, the poverty rates are at least five percentage points greater than the state average in 11 counties. These counties include Butte, Del Norte, Fresno, Imperial, Kern, King, Lake, Madera, Merced, Siskiyou, and Tehama.[21]
In a joint project between the Public Policy Institute of California and Stanford University, researchers developed an index called the California Poverty Measure, which reportedly improves conventional poverty measures by accounting for a range of costs associated with living expenditures and family resources, such as food stamps.[22]
Based on this index, an estimated 7.4 million residents live in poverty and another 2.1 million live in deep poverty. The percent of residents in poverty under this measure has declined from 22% in 2011 to 19% in 2016. The proportion of those living in poverty would be higher without key safety net programs. For instance, the poverty rate would increase to 20% without WIC and 21% without Cal-FRESH. The rate would increase to nearly 32% without all safety net programs.[23]
Food insecurity refers to the United States Department of Agriculture’s (USDA) measure of access to enough food for an active, healthy life for all household members. Food insecurity can have devastating effects on pregnant women and young children. Women experiencing food insecurity during pregnancy are more likely to experience birth complications than women who are food-secure. For children, inadequate nutrition can permanently alter brain development, affecting children’s life-long learning, social interactions, and productivity.[24]
The USDA estimates that over 4 million people living in California, including 1.6 million children, are food insecure as of 2017. That means that 1 in 9 individuals (11%) and 1 in 6 children (18.1%) live in households without consistent access to adequate food.[25] Between 2013 and 2015, nearly 1 in 6 women (15.6%) in California experienced food insecurity during pregnancy.[26] Los Angeles has 1.1 million individuals at risk of hunger, including more than 410,000 children, which is the highest number of individuals living in food insecure households in the nation. The average meal cost ($3.39) in Los Angeles is substantially higher than the national average ($3.02).[27]
The population of children aged 0 to 19 years in California is projected to remain stable in the 10.4 million range between 2019 and 2025. Over the next four decades, the number of female children is expected to decrease by nearly 2%, while the number of male children is expected to increase by 1%.[28]
About 8 million women of reproductive age (15 to 44 years) reside in California. This number is projected to increase to nearly 8.2 million by 2025 and 8.5 million by 2060, representing an overall increase of 7% over the next four decades. Most of this growth will be among women in the 25-to-37 age group (14%) followed by those in the 40 to 44 age group (7%).[29]
There are over 1,000 public school districts located throughout the state serving 6.2 million students. Nearly half (49%) of all students are enrolled in elementary school.[30]
There are 23 campuses belonging to the California State University system and 10 campuses belonging to the University of California system. [31], [32] There are 115 campuses belonging to the California Community College system. Together, these systems of higher education teach about 2.8 million college-age students each year. This does not include the number of students enrolled in private schools and universities.
California serves the largest number of students under the Individuals with Disabilities Education Act followed by New York and Texas. More than 760,000 students in the state’s public schools are identified as needing special education services. This accounts for 11% of all students enrolled in the public school system.[33]
California ranks ninth highest in the nation for change in single-family home prices over a five-year period ending in the third quarter of 2018, according to the Federal Housing Finance Agency.[34]
The California Department of Housing and Community Development projects that there will continue to be severe housing issues for both rental and homeownership. From 2015 to 2025, about 1.8 million new housing units will be needed to meet the projected growth in population and household. In other words, the demand for housing will be compounded by both the expected growth in the state population and the expected growth in the size of individual households. Over two-thirds (69%) of all households cannot afford the median price of a house.[35]
The median price of a single-family house in California ranges from $184,000 in Lassen to $1,500,000 in Marin. The median price in many counties are over $700,000. They include Alameda, San Francisco, San Mateo, Santa Clara, Orange, and Santa Cruz. Counties with a median price of $250,000 or less include Glenn, Kern, Kings, Del Norte, Lassen, Siskiyou, and Tehama.[36]
According to a congressional report by the U.S. Department of Housing and Urban Development, an estimated 130,000 persons were homeless in California during a single night in January 2018. This represents a decrease of 1% from 2017, but an increase of 5% since 2010.[37]
About 16% of the total homeless persons in 2018 were families with children. Another 10% were children unaccompanied by a parent or guardian. San Jose and Santa Clara counties combined had the highest rate in the nation for unaccompanied homeless children living in the streets or other places not designated for a regular sleeping accommodation.
MIHA data showed that homelessness and housing instability among pregnant women in California is alarmingly common. In 2017, approximately 14,600 women with a recent birth (3.2%) experienced homelessness. Homelessness during pregnancy was more common among Black women, women aged 15-19 years old and those with lower income, as well as women experiencing depressive symptoms, intimate partner violence, or lack of emotional support during pregnancy. Homelessness during pregnancy was higher for women living in Humboldt, Kern, Monterey, San Bernardino, and Shasta counties.[38]
The connections between transportation and public health are numerous and varied, touching on physical inactivity, incomplete streets, injury, poor air quality, and differential access to services, such as health care services. In California, access issues can be complicated, given the geographic diversity and distribution of providers. For example, the Los Angeles Mommy and Baby Study determined that poor geographic accessibility to care was associated with travel burdens for pregnant women.[39]
About 2.8 million residents in California – or 7% of the state population – do not have health insurance coverage.[40] This includes about 291,000 children age 0 to 18 years and 753,000 adults with dependent children.[41], [42] The population groups with the highest rates of uninsured are non-elderly residents at 100 to 199% of the federal poverty level (13%) and residents identified as either American Indian-Alaska Native (12%) or Hispanic (12%).[43], [44] Based on data from the MIHA survey, other population subgroups with high rates of being uninsured include pre-pregnant women (22%) and postpartum women (13%).[45]
The rates of insurance coverage vary between counties as well as between population groups within each county. Based on annual estimates for 2017, the lowest rates of uninsured residents were located in El Dorado, Marin, Placer, San Francisco, and Yolo Counties. Each of them had a rate lower than 4%.[46]
Twelve percent of the state’s population aged 26 to 34 years were uninsured compared with 11% of those aged 19 to 25 years and 3% of those aged 6 to 18. The highest rates of uninsured residents aged 26 to 34 were located in Humboldt, Mendocino, Monterey, Nevada, and Ventura Counties. Each had a rate of 16% or more. [47]
The Patient Protection and Affordable Care Act has reduced the number of uninsured residents in California. Overall, there was an 11% point decrease in the rate of uninsured non-elderly persons from 19.4% in 2013 to 8.2% in 2017.[48]
More recent estimates show that, accounting for all age groups, there are about 13.1 million Medicaid-certified eligible persons in the state. This includes both dual eligible and non-dual eligible persons. The number of eligible persons has increased nearly 3% since June 2015. Most of the eligible persons (82%) are served under its managed care program.[49]
California’s governmental structure is composed of three branches: the legislative, the executive, and the judicial. The executive branch is responsible for administering and enforcing the laws of California. The executive branch houses more than 100 offices, agencies, and departments. One of these agencies is the California Health and Human Services Agency. This agency contains twelve individual departments, including CDPH.
California’s governmental structure is also geographically divided into counties, which are legal subdivisions of the State. For the purposes of administering CDPH/MCAH programs, the California Health and Safety Code goes further to divide the government structure into local health jurisdictions (LHJs), which are defined by the California Health and Safety Code as county health departments or combined health departments.[50] In California, 61 LHJs directly administer CDPH/MCAH programs within their regions.
Out of the 58 counties in California, 29 counties have a population of 200,000 or less. Seven counties have a population under 20,000. Alpine and Sierra counties each have less than 4,000 residents.[51] This presents unique challenges to implementing local MCAH programs, particularly among those located in rural areas where they might face an array of region-specific challenges, such as staff recruitment or retention. The California Office of Statewide Health Planning reports that an estimated 17.1 million residents live in locations designated as having a workforce shortage of providers – 8.8 million live in areas with a shortage of primary care providers, 6.4 million live in areas with a shortage of mental health providers, and 1.9 million live in areas with a shortage of dental health providers.[52]
Many counties do not have any providers that can provide complete perinatal services. Pregnant woman must receive services out of the county, which lead to long driving distances. Many providers do not accept Med-Cal Managed Care, which forces Medi-Cal clients to either go out of county or switch their assigned plan. According to the March of Dimes, five of the 58 counties in California do not have hospitals offering obstetric care and have no obstetric providers: Alpine, Colusa, Glenn, Modoc, and Sierra County.
Another challenge is the issues of labor and workload. For instance, one staff member might be responsible for administering several programs within a small LHJ, while a team of staff members might be responsible for administering one program within a large LHJ. This has led some jurisdictions to pool their resources with neighboring jurisdictions to improve service provision and program efficiency.
There are more than 6,000 licensed healthcare facilities in the state. These facilities include, but are not limited to, 445 general acute care hospitals, 1,407 community clinics, 46 free clinics, 38 acute psychiatric hospitals, 30 psychiatric health facilities, 13 alternative birthing centers, 258 birthing hospitals and six chemical dependency recovery centers. The ten largest general acute care hospitals are located in eight counties: Fresno, Los Angeles, Orange, San Diego, San Francisco, Santa Clara, Sonoma, and Tulare. Each facility has a capacity of more than 600 beds.[53]
According to the Children’s Hospital Association, there are 23 children’s hospitals located throughout California.[54] These hospitals are located within 10 counties across the state, such as Madera, San Bernardino, and Santa Clara. Nearly 81% of all counties do not have a designated children’s hospital to provide pediatric care within their county. However, although some counties like Contra Costa and Fresno do not have a Children’s hospital in the county, they have a designated Children’s hospital for referrals in neighboring counties and regions.
[1] U.S. Bureau of the Census. ACS Demographic and Housing Estimates, 2013-2017 American Community Survey 5-Year Estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_5YR_DP05&src=pt. Accessed January 4, 2019.
[2] U.S. Bureau of the Census. GCT-PH1. Population Housing Units, Area, and Density: 2010: United States – States: and Puerto Rico 2010 Census Summary File 1. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed January 4, 2019.
[3] California State Association of Counties. Square Mileage by County. http://www.counties.org/pod/square-mileage-county. Accessed January 4, 2019.
[4] U.S. Bureau of the Census. Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2017. 2017 Population Estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2017_PEPANNRES&src=pt. Published May 2018. Accessed January 3, 2019.
[5] California Department of Finance. P-1 State Population Projections 2010-2060. http://www.dof.ca.gov/Forecasting/Demographics/Projections/. Published January 2018. Accessed January 3, 2019.
[6] California Department of Finance. P-2 County Population Projections 2010-2060. http://www.dof.ca.gov/Forecasting/Demographics/Projections/. Published January 2018. Accessed January 3, 2019.
[7] California Department of Finance. P-2 County Population Projections 2010-2060. http://www.dof.ca.gov/Forecasting/Demographics/Projections/. Published January 2018. Accessed January 3, 2019.
[8] U.S. Bureau of the Census. C02003. Detailed Race, Total Population, 2013-2017 American Community Survey 5-Year Estimates. https://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t. Accessed January 4, 2019.
[9] U.S. Bureau of the Census. Asian Alone or in Any Combination by Selected Groups, 2013-2017 American Community Survey 5-Year Estimates. https://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t. Accessed January 4, 2019.
[10] Motel, S, & Patten E. The 10 Largest Hispanic Origin Groups: Characteristics, Rankings, Top Counties. Pew Research Center Website. http://www.pewhispanic.org/2012/06/27/the-10-largest-hispanic-origin-groups-characteristics-rankings-top-counties/. Published June 2012. Accessed January 4, 2019.
[11] Johnson, H., & Hans, J. Immigrants in California. Public Policy Institute of California. Public Policy Institute of California Website. https://www.ppic.org/wp-content/uploads/jtf-immigrants-in-california.pdf. Published May 2018. Accessed January 4, 2019.
[12] Hayes, J., & Hill, L. Undocumented Immigrants in California. Public Policy Institute of California Website. https://www.ppic.org/content/pubs/jtf/JTF_UndocumentedImmigrantsJTF.pdf. Published March 2017. Accessed January 4, 2019.
[13] U.S. Bureau of the Census. B16004. Age by Language Spoken at Home by Ability to Speak English for the Population 5 Years and Over, 2017 American Community Survey 1-Year Estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_1YR_B16004&prodType=table. Accessed January 4, 2019.
[14] U.S. Bureau of the Census. Language Spoken at Home for the Population 5 Years and Over: 2000. Special Tabulation. https://www.census.gov/data/tables/2000/dec/stp-224.html. Published April 2004. Accessed January 4, 2019.
[15] U.S. Bureau of the Census. B16004. Age by Language Spoken at Home by Ability to Speak English for the Population 5 Years and Over, 2017 American Community Survey 1-Year Estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_1YR_B16004&prodType=table. Accessed January 4, 2019.
[16] California Department of Finance. Gross State Product, Comparison to other Major Countries. http://www.dof.ca.gov/Forecasting/Economics/Indicators/Gross_State_Product/. Accessed January 4, 2019.
[17] California Department of Finance. Gross State Product, Gross State Product in California. http://www.dof.ca.gov/Forecasting/Economics/Indicators/Gross_State_Product/. Accessed January 4, 2019.
[18] U.S. Department of Commerce, Bureau of Economic Analysis. California. https://www.bea.gov/regional/bearfacts/pdf.cfm?fips=06000&areatype=STATE&geotype=3. Published September 2018. Accessed January 4, 2019.
[19] Bohn, S., & Danielson, C. Income inequality and the Safety Net in California. Public Policy Institute of California Website. https://www.ppic.org/content/pubs/report/R_516SBR.pdf. Published May 2016. Accessed January 4, 2019.
[20] U.S. Bureau of the Census. S1701. Poverty Status in the Past 12 Months. 2013-2017 American Community Survey 5-Year Estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_5YR_S1701&prodType=table. Accessed January 4, 2019.
[21] U.S. Bureau of the Census. S1701. Poverty Status in the Past 12 Months. 2013-2017 American Community Survey 5-Year Estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_5YR_S1701&prodType=table. Accessed January 4, 2019.
[22] Stanford Center on Poverty and Inequality. California Poverty Measure. https://inequality.stanford.edu/publications/research-reports/california-poverty-measure. Accessed January 4, 2019.
[23] Wimer, C., Mattingly, M., Kimberlin, S., Fisher, J., Danielson, C., Bohn, S. 2.1 Million Californians in Deep Poverty. Stanford University, Stanford Center on Poverty and Inequality, Website. https://inequality.stanford.edu/sites/default/files/california_poverty_measure_2016.pdf. Published July 2018. Accessed January 4, 2019.
[24] Gunderson, C., A. Dewey, M. Kato, A. Crumbaugh & M. Strayer. Map the Meal Gap 2019: A Report on County and Congressional District Food Insecurity in the United States in 2017. Feeding America, 2019. https://www.feedingamerica.org/sites/default/files/2019-05/2017-map-the-meal-gap-full.pdf
[25] Gunderson, C., A. Dewey, M. Kato, A. Crumbaugh & M. Strayer. Map the Meal Gap 2019: A Report on County and Congressional District Food Insecurity in the United States in 2017. Feeding America, 2019. https://www.feedingamerica.org/sites/default/files/2019-05/2017-map-the-meal-gap-full.pdf
[26] Maternal and Infant Health Assessment (MIHA) Survey Data Snapshots, 2013-2015. California Department of Public Health; 2018.
[27] Gunderson, C., A. Dewey, M. Kato, A. Crumbaugh & M. Strayer. Map the Meal Gap 2019: A Report on County and Congressional District Food Insecurity in the United States in 2017. Feeding America, 2019. https://www.feedingamerica.org/sites/default/files/2019-05/2017-map-the-meal-gap-full.pdf
[28] California Department of Finance. P-1 State Population Projections 2010-2060. http://www.dof.ca.gov/Forecasting/Demographics/Projections/. Published January 2018. Accessed January 7, 2019.
[29] California Department of Finance. P-1 State Population Projections 2010-2060. http://www.dof.ca.gov/Forecasting/Demographics/Projections/. Published January 2018. Accessed January 7, 2019.
[30] California Department of Education. Fingertip Facts on Education in California. https://www.cde.ca.gov/ds/sd/cb/ceffingertipfacts.asp. Published July 2018. Accessed January 2, 2019.
[31] California State University. Fact Book 2018. https://www2.calstate.edu/csu-system/about-the-csu/facts-about-the-csu/Documents/facts2018.pdf. Accessed January 2, 2019.
[32] University of California. UC System Overview. https://www.universityofcalifornia.edu/uc-system. Accessed January 2, 2019.
[33] U.S. Department of Education. Number of Children and Students Served under IDEA, Part B, by Age Group and State, 2017-18. https://www2.ed.gov/programs/osepidea/618-data/static-tables/index.html. Published December 2018. Accessed January 2, 2019.
[34] Federal Housing Finance Agency. Change in FHFA State House Price Indexes (Seasonally Adjusted, Purchase-Only Index, 2018Q3). https://www.fhfa.gov/DataTools/Tools/Pages/House-Price-Index-(HPI).aspx. Accessed January 2, 2019.
[35] California Department of Housing and Community Development. California’s Housing Future: Challenges and Opportunities Final Statewide Housing Assessment 2025. http://www.hcd.ca.gov/policy-research/plans-reports/docs/SHA_Final_Combined.pdf. Published February 2018. Accessed January 7, 2019.
[36] California Association of Realtors. California Housing Market Update, Monthly Sales and Price Statistics. https://www.car.org/en/marketdata/data/countysalesactivity. Published November 2018. Accessed January 7, 2019.
[37] U.S. Department of Housing and Urban Development, Office of Community Planning and Development. The 2018 Annual Homeless Assessment Report to Congress: Part 1: Point-in-Time Estimates of Homelessness. https://www.hudexchange.info/resources/documents/2018-AHAR-Part-1.pdf. Published December 2018. Accessed January 2, 2019.
[38] Maternal and Infant Health Assessment (MIHA) Survey, 2017. California Department of Public Health; 2019.
[39] Lu Shi, Kara E. MacLeod, Donglan Zhang, Fan Wang & Margaret Shin Chao (2017) Travel distance to prenatal care and high blood pressure during pregnancy, Hypertension in Pregnancy, 36:1, 70-76, DOI: 10.1080/10641955.2016.1239733.
[40] Henry J. Kaiser Family Foundation. Health Insurance Coverage of the Total Population: State Health Facts. https://www.kff.org/state-category/health-coverage-uninsured/. Accessed January 3, 2019.
[41] Henry J. Kaiser Family Foundation. Health Insurance Coverage of Children 0-18: State Health Facts. https://www.kff.org/state-category/health-coverage-uninsured/. Accessed January 3, 2019.
[42] Henry J. Kaiser Family Foundation. Health Insurance Coverage of Adults with Dependent Children: State Health Facts. https://www.kff.org/state-category/health-coverage-uninsured/. Accessed January 3, 2019.
[43] Henry J. Kaiser Family Foundation. Uninsured Rates for the Nonelderly by Race/Ethnicity: State Health Facts. https://www.kff.org/state-category/health-coverage-uninsured/. Accessed January 3, 2019.
[44] Henry J. Kaiser Family Foundation. Uninsured Rates for the Nonelderly by Federal Poverty Level: State Health Facts. https://www.kff.org/state-category/health-coverage-uninsured/. Accessed January 3, 2019.
[45] California Department of Public Health. Maternal and Infant Health Assessment (MIHA) Survey Data Snapshots, 2013-2015. https://www.cdph.ca.gov/Programs/CFH/DMCAH/MIHA/CDPH%20Document%20Library/2013-2015/Snapshot_ByMaternalAge_2013-2015.pdf. Assessed January 7, 2019.
[46] U.S. Bureau of the Census. S2701. Select Characteristics of Health Insurance Coverage in the United States, 2017 American Community Survey 1-Year Estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_1YR_S2701&prodType=table. Accessed January 7, 2019.
[47] U.S. Bureau of the Census. S2701. Select Characteristics of Health Insurance Coverage in the United States, 2017 American Community Survey 1-Year Estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_1YR_S2701&prodType=table. Accessed January 7, 2019.
[48] Henry J. Kaiser Family Foundation. Key Facts about the Uninsured Population. http://files.kff.org/attachment//fact-sheet-key-facts-about-the-uninsured-population. Published December 2018. Accessed January 3, 2019.
[49] California Department of Health Care Services. Medi-Cal Monthly Enrollment Fast Facts: Characteristics of the Medi-Cal population as captured by the Medi-Cal Eligibility Data System. https://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_June2018_ADA.pdf. Published June 2018. Accessed January 3, 2019.
[50] California Health and Safety Code. Division 106. Personal Health Care (Including Maternal, Child, and Adolescent) Part 2. Maternal, Child, and Adolescent Health [123225-124250]. http://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=HSC&division=106.&title=&part=2.&chapter=3.&article=6. Accessed January 2, 2019.
[51] California Department of Finance. P-1 State Population Projections 2010-2060. http://www.dof.ca.gov/Forecasting/Demographics/Projections/. Published January 2018. Accessed January 3, 2019.
[52] California Office of Statewide Health Planning & Development. Primary Care Health Professional Shortage Area (HPSA) - Census Detail. https://data.chhs.ca.gov/dataset/primary-care-health-professional-shortage-area-hpsa-census-detail. Accessed January 2, 2019.
[53] California Office of Statewide Health Planning & Development. Facility Finder. https://oshpd.ca.gov/facility-finder. Accessed January 2, 2019.
[54] Children’s Hospital Association. Children’s Hospital Directory. https://www.childrenshospitals.org/Directories/Hospital-Directory. Accessed January 2, 2019.
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