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Universal Health Coverage in California: Progress and Key Policy Actions

November 2024 | By Adriana Ramos-Yamamoto

A young female of Indian ethnicity sits on the examination table at her doctor's office. She is talking to her doctor about her health history.

Affordable health care is essential for everyone to be healthy and thrive. Having health insurance coverage helps lower out-of-pocket expenses and ensures access to preventive care, which in turn supports workforce participation and education. While California has made great strides in lowering the uninsured rate and expanding health care access, policymakers can take further action to protect progress and achieve universal health care coverage.

1. Medi-Cal Covers Over a Third of the State’s Population

Medi-Cal, California’s Medicaid program, provides free or low-cost health care to over one-third of the state’s population. The program covers a wide range of services to Californians with modest incomes, and many children, seniors, people with disabilities, and pregnant individuals rely on it. Medi-Cal plays a crucial role in promoting health equity, with about half of its beneficiaries being Latinx Californians, who often face low-wage employment and limited access to employer-sponsored health plans. For those who earn too much to qualify for Medi-Cal, Covered California — the state’s health insurance marketplace established through the Affordable Care Act — serves as a vital resource, helping individuals and families find affordable health coverage. Nearly 1.8 million Californians purchase their insurance through this state marketplace.

2. California’s Uninsured Rate Reached a Historic Low in 2023

California has made substantial progress in expanding access to health coverage over the past decade. Key drivers of this success include the federal Affordable Care Act and more recent state initiatives, such as expanding full-scope Medi-Cal to income-eligible Californians who are undocumented. As a result, the uninsured rate dropped to 6.4% in 2023, matching the record low of 6.4% in 2022. These gains reflect a major shift from a decade ago when over 17% of Californians lacked health coverage, underscoring the state's commitment to improving health care access for all.

3. American Indian or Alaska Native Californians Have the Highest Uninsured Rate

Despite California’s overall progress in expanding health coverage, significant racial disparities persist. American Indian or Alaska Native Californians face the highest uninsured rate among all racial and ethnic groups in the state. The racial disparities in health coverage highlight the profound and enduring impact of racism, which blocks Californians of color from equal access to health care. Addressing the racial disparities in health coverage requires targeted outreach and education efforts along with other antiracist policy actions to improve health and well-being for Californians of color.

4. Too Many Californians Lost Medi-Cal Coverage Due to Paperwork Challenges

When California resumed Medi-Cal renewals in 2023, after pausing them during the pandemic, many Californians were disenrolled from Medi-Cal. This process, known as the "unwinding period," marked the end of the federal policy that temporarily paused routine renewals.1A provision in the federal Families First Coronavirus Response Act passed in March 2020 required states to provide continuous coverage for Medicaid beneficiaries in exchange for enhanced federal funding during the federally declared Public Health Emergency (PHE). The Consolidated Appropriations Act of 2023, which federal policymakers passed in December 2022, delinked the continuous coverage provision from the PHE, thereby ending this provision on March 31, 2023. Over 1.8 million Californians lost Medi-Cal coverage from June 2023 to July 2024.2The California Department of Health Care Services publishes interactive dashboards detailing statewide and county-level demographic data on Medi-Cal application processing, enrollments, redeterminations, and renewal outcomes. The majority of disenrollments (85.2%) were due to challenges with the renewal paperwork. Completing the renewal process often involves complex paperwork and documentation requirements, which can be challenging to navigate. Additionally, many Californians have experienced extended call wait times when attempting to contact county Medi-Cal workers regarding their application. The high disenrollment rate underscores the need to further streamline the renewal process as well as permanently enact policies that build upon lessons learned during the pandemic.

5. Many Californians Could Lose Health Coverage if Premium Tax Credits Expire

Enhanced premium tax credits from recent federal policy actions have significantly improved health care affordability for many Covered California enrollees. However, these credits are set to expire at the end of 2025, which would lead to steep increases in monthly premiums. About 2.4 million Californians in the individual market would face higher health insurance premiums if Congress does not extend the expanded federal subsidies, according to the UC Berkeley Labor Center. The loss of these tax credits means that average premiums could rise by 63% for Covered California enrollees, and communities of color will be disproportionately impacted. Premiums will increase by 76% for Latinx enrollees, 67% for Black enrollees, and 71% for Asian enrollees, compared to a 57% increase for white enrollees. Overall, without these federal subsidies, an estimated 138,000 to 183,000 Covered California enrollees would disenroll.

Looking Ahead, Policymakers Can Take Action to Strengthen Health Coverage

While California has made substantial progress, challenges remain in ensuring health coverage for everyone. By addressing gaps in coverage, particularly for historically underserved communities, state leaders can continue leading the nation in advancing health equity and improving well-being for all Californians.

Key policy recommendations include:

Health & Safety Net
  • 1
    A provision in the federal Families First Coronavirus Response Act passed in March 2020 required states to provide continuous coverage for Medicaid beneficiaries in exchange for enhanced federal funding during the federally declared Public Health Emergency (PHE). The Consolidated Appropriations Act of 2023, which federal policymakers passed in December 2022, delinked the continuous coverage provision from the PHE, thereby ending this provision on March 31, 2023.
  • 2
    The California Department of Health Care Services publishes interactive dashboards detailing statewide and county-level demographic data on Medi-Cal application processing, enrollments, redeterminations, and renewal outcomes.

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key takeaway

California’s paid family leave program excludes many workers, especially LGBTQ+ and immigrants, from taking leave to care for loved ones because the program’s definition of family is too narrow. Expanding the definition to include designated family members would allow more workers to access the program without straining the system’s finances.

All California workers should be able to care for their loved ones when they are ill without worrying about their next paycheck. However, many Californians have close relationships with extended or chosen family members who are not currently covered by the state’s paid family leave program. Although the program is funded entirely by worker contributions, some workers – especially those who are LGTBTQ+ and immigrants – are excluded from taking leave for their loved ones.

Policymakers can make the state’s paid family leave program more inclusive and accessible to all workers by expanding the definition of family to include a designated, or chosen, family member.

what is chosen family?

Chosen family refers to individuals who love and support each other like a family might, but do so by choice rather than based on biological or legal bonds.

1. California’s Current Definition of Family Excludes Millions

Approximately 10% of Californians live with someone who isn’t currently included in California’s definition of family. Workers in California can currently take paid family leave to care for a sick family member if that family member is a: grandparent, grandchild, sibling, parent-in-law, parent, child, spouse, or registered domestic partner. However, around 3.5 million Californians, or 10% of the population, live in households with someone not included in this definition, such as an unmarried partner or other relative, meaning they are unable to take paid leave to care for these individuals because of the state’s definition of family. This is especially the case for immigrants, who make up 28% of the state population and are more likely to live in multigenerational households.

Additionally, there are about 2.7 million (or 1 in 10) LGBTQ+ individuals in California, which is the most in the US. Members of the LGBTQ+ community tend to rely on chosen family, or people outside of the traditional family definition, who are not currently covered by California’s paid family leave program to care for them when they are sick. That means these individuals’ chosen family, who pay a certain percentage of their paycheck every month into the state’s paid family leave fund, are not able to care for them in their time of need.

2. There is National Precedent for Expanding the Definition of Family

Seven states have more inclusive family definitions than California. While California was the first state in the country to enact a paid family leave program in 2004, other states have since established their own programs that are more inclusive. Washington, New Jersey, Oregon, Connecticut, Colorado, Minnesota, and Maine all include people who are related to the worker by blood or affinity (chosen family) in their definition of a family member.

3. Making Paid Family Leave More Inclusive Maintains Program Stability

There is minimal impact on states’ paid family leave disbursement funds. Washington expanded their definition of a family member in 2021 to include chosen family members. In that time, only 0.22% of claims filed for paid family leave have been used for a chosen family member. Although an expanded family definition has an immense impact on the lives of those individuals who do not fit under the traditional family definition, the actual impact on a state’s paid family leave disbursement fund is very small, yet the positive effect for families is meaningful.

4. Including a Designated Family Member Does Not Strain State Funds

When Washington expanded their definition of a family member to include a chosen family member, language was included in the policy that if over 500 individuals filed claims for expanded family members, a reimbursement from the state’s General Fund would be triggered. This was to ensure that the paid family leave fund would remain solvent even with the anticipated increase in the number of claims filed. However, that number was not met in 2021 or 2022 (a total of 686 claims were filed from July 25, 2021 to March 30, 2023), so $0 have been needed to reimburse the fund from the General Fund, further suggesting that adding a chosen family member will not strain a state’s disability insurance fund.

5. Current Contribution Rates Support Expanded Definition of Family Leave

Currently, workers in California pay 1.1% of their wages to the State Disability Insurance fund to pay for the state’s paid family leave and disability insurance programs. With a very liberal estimate on the number of claims that will go up if designated family members are added, the Employment Development Department (EDD) estimates family leave expansion will have zero impact on worker payroll contribution rates for 2025 and 2026 and a 0.1 percentage point increase in 2027. Additionally, data from Washington point to expanded family member claims having no impact on payroll contribution rates in the years after expansion. While the EDD suggests that expansion may increase rates by 0.1 percentage points, the Washington example suggests that even this modest increase may be overestimated.

California workers provide 100% of the funding for the state’s disability insurance fund, which provides payments for paid family leave benefits. However, many workers are blocked from accessing paid family leave for their family because they do not fit the strict definition of family used in the state — this is especially true for LGBTQ+ Californians and immigrant communities. California can ensure equitable access to paid family leave and catch up to other states’ more inclusive policies by expanding their family definition to include a designated chosen family member.

Health & Safety Net

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key takeaway

California’s homeless population is aging rapidly, with adults 50+ making up nearly 40% of those needing shelter. Without swift and intentional policy action, California faces a future with a growing number of unhoused older adults as the state’s population ages.

Every Californian deserves an affordable, dignified, and accessible home, regardless of their age, ability, race, gender, or economic status. Yet thousands of Californians — increasingly composed of older adults age 50 and over — continue to fall into homelessness faster than our systems can house them. During the course of the 2022-23 fiscal year, local California homeless service providers made contact with over 215,000 adults without children needing to find a home or search for other life-sustaining services — and even more were likely served by the end of 2023.1Adults without children, also referred to as single adults, are categorized by the US Department of Housing and Urban Development as being age 25 and over. This includes sole individuals, adult couples with no children, groups of adults, and may capture noncustodial parents. Sole individuals ages 18 to 24 are considered unaccompanied  youth. The terms homeless and unhoused are also used interchangeably. Of these, 85,310 — nearly 40% — were adults age 50 and over. While experiencing homelessness at any age is severely destructive to an individual’s well-being, older adults are the fastest-growing population experiencing homelessness and the largest share of individuals who are encountering homelessness for the first time in their lives. Without swift and intentional policy action, California faces a future with a growing number of unhoused older adults as the state’s population ages.

Understanding the diverse characteristics, circumstances, and tailored interventions unhoused older Californians need is key to effectively addressing their housing needs and solving homelessness across the state.

“Older adults” refers to individuals who are age 50 and over. This determination was made to parallel current research on older adults at risk of or experiencing homelessness. It also acknowledges the increased physical and behavioral health vulnerabilities that are being experienced by unhoused individuals aged 50 and over which have been traditionally seen in older populations and require tailored interventions.

1. Older Californians Are a Large Share of the Unhoused Population

Unhoused Californians age 50 and over comprised 40% of adult-only households who connected with the homelessness response system in the 2022-23 fiscal year. Yet older adults account for only 34% of the state’s entire population.

Research identifies two main cohorts that are driving the growth in older adult homelessness:

Prolonged economic hardship and insufficient wages have also prevented many from building savings or retirement accounts, leading to economic insecurity among older Californians. Adults without children are also ineligible for many cash-based safety net programs as they typically target people with children.2For more on the shortfalls of safety net programs for low-income non-elderly adults see: Joseph Llobrera et al., A Frayed and Fragmented System of Supports for Low-Income Adults Without Minor Children (Center on Budget and Policy Priorities, January 28, 2021), https://www.cbpp.org/research/a-frayed-and-fragmented-system-of-supports-for-low-income-adults-without-minor-children#state-general-assistance-programs-provide-cbpp-anchor. 

Available programs often have minimal benefit amounts that are even lower for adults without dependents. Some program benefits vary by county (particularly for General Assistance/General Relief), have time restrictions, strict asset limits, and may require an age threshold or a physical/developmental disability. Nationally, inadequate rental assistance funding also prevents more than 4 in 5 low-income, non-elderly adult households without children from obtaining the support they qualify for.3General Assistance/General Relief which is a state-mandated program that counties must offer to indigent adults. Each California county administers and fully funds its own program and sets their own benefits, payment levels, and eligibility requirements. Regardless of the circumstances leading to homelessness for older adults, it is clear that there is an urgent need for amplified, targeted safety net and housing interventions at various points to ensure aging Californians can remain in their homes.

2. Stark Racial Disparities Persist in California’s Unhoused Older Adult Population

Older Black, Indigenous, and Pacific Islander Californians disproportionately experience homelessness in California. While Black Californians age 50 and older make up roughly 5.4% of the state’s population, they comprised over 1 in 4 (26%) older adults who made contact with homeless service providers in the 2022-23 fiscal year. Disparities are also evident within Indigenous and Pacific Islander communities, with Indigenous individuals being almost six times as likely and Pacific Islanders twice as likely to connect with the homelessness response system. Separate data from the state’s point-in-time counts reflect homelessness increased among Latinx Californians across the whole population, which captures older adults as well.

The stark racial disparities parallel the broader racial disparities observed in California's unhoused population, underscoring that people of color bear the disproportionate and harmful impacts of homelessness. These disparities reflect the enduring effects of intentional racist policies that created educational, housing, economic, and health barriers for people of color — all of which directly affect an individual’s ability to obtain and sustain stable housing, especially at older ages.

Racist institutionalized practices, such as redlining, government-sanctioned displacement, and predatory practices, have placed generations in positions that make it harder to obtain housing and economic security.4For more see: Danyelle Solomon, Connor Maxwell, and Abril Castro, Systemic Inequality: Displacement, Exclusion, and Segregation: How America's Housing System Undermines Wealth Building in Communities of Color (Center for American Progress, August 7, 2019),  https://www.americanprogress.org/article/systemic-inequality-displacement-exclusion-segregation/ and California Department of Justice, California Task Force to Study and Develop Reparation Proposals for African Americans, The California Reparations Report (2023), https://oag.ca.gov/ab3121/report.

Discriminatory practices have also caused Black and other communities of color to face the highest risk of justice system involvement, familial disruptions, and traumatic experiences which can cause and exacerbate homelessness throughout a lifetime.

3. Most Unhoused Older Adults Have a Disabling Condition

Most older adults experiencing homelessness reported having a disabling condition (72%) in the 2022-23 fiscal year. Disabling conditions include physical, mental, or emotional impairments that are long continuing, significantly impeding an individual’s ability to live independently, and could be improved with housing. It also captures people with developmental disabilities. Research demonstrates many unhoused individuals experience health conditions and mobility limitations prematurely, often decades before housed adults of the same age. The striking differences reflect the detrimental health effects experiencing homelessness has on the lives of Californians, especially as they age. This pivotal factor underscores the need for policy interventions to be both accessible and tailored to the diverse demographic of older adults starting at age 50.

Unhoused Californians face steep barriers to medical access, face daily safety concerns, and often have limited access to basic necessities such as consistent meals, proper medication storage, and sanitation. Even temporary homeless shelters are often not equipped to accommodate older individuals with complex medical or mobility conditions. Combined, the lack of access to care, medical support, and appropriate housing exacerbates negative health outcomes. Experiencing homelessness ultimately limits the opportunity to live a long, healthy life and reach older ages, which is reflected by higher mortality rates in unhoused populations when compared to their housed counterparts.

Ensuring older unhoused Californians with disabilities have appropriate housing and care is largely achievable through scaling supportive housing. This effective, evidence-based intervention combines robust housing interventions with wraparound supportive services to meet the medical, physical, and behavioral health needs of unhoused Californians with disabling conditions.

4. Most Unhoused Older Adults Have an Income Source —  But It's Not Enough

Most unhoused older adults who made contact with homeless service providers in the 2022-23 fiscal year reported having at least one source of income. These older adults had a median total monthly income of $1,000 —  an amount that cannot cover fair market rent for a studio apartment in nearly 70% of the state’s counties, let alone other basic living expenses like food, utilities, and transportation.

The top three reported income sources were Supplemental Security Income (SSI) (median = $1,037), Social Security Disability Insurance (SSDI) (median = $1,040), and General Assistance (median = $221). All of which reflect the very low incomes and high rates of disabling conditions among the unhoused older adult population. Additionally, nearly 25% of individuals with an income source reported having income from work.

The limited state and federal aid available to adults without children, low-income seniors, and people with disabilities cannot cover the high cost of housing and other basic needs in California creating vulnerabilities that can lead to homelessness. Benefit amounts are insufficient and often have strict asset limits, placing Californians who depend on these supports in severe economic hardship. In 2022, only 24 housing units were affordable and available for every 100 extremely low-income renter households, which older adults on fixed incomes often fall into. The misalignment between safety net income supports and housing costs highlights the urgent need for significant investments in accessible, affordable housing and cash supports to prevent homelessness among older adults.

5. High Housing Costs Drive Homelessness Among Older Californians

The severe shortage of affordable housing in California, leading to skyrocketing housing costs, is the primary factor pushing older adults into homelessness. In 2022, over half (52%) of all older adult California renters were housing cost-burdened, paying more than 30% of their total income in rent, and nearly 1 in 3 (29%) were severely cost-burdened, paying more than 50% of their income in rent. Older Black California renters faced the highest rates, with over 60% paying unaffordable housing costs. Older Californians of color broadly are especially vulnerable to housing insecurity as they are more likely to be renters and consequently do not have home equity to potentially fall back on. Nearly half (45.7%) of older Black Californians are renters, followed by older Latinx (37.1%), other Californians of color (29.6%), and Asian Californians (26.1%).

The increased share of Californians of color in renter households reflects discriminatory policies that have perpetuated the racial wealth gap and limited access to housing and other opportunities, leading to adverse outcomes in later life. As housing costs comprise a significant portion of their income, older adult renters — especially those with low or fixed incomes — are left with fewer resources for essentials like transportation, medicine, and food. This precarious situation can be the tipping point into homelessness due to minor financial setbacks, medical expenses, or rent hikes. Ultimately, California’s housing shortage places older renters in situations where they have to pay more than they can afford, exacerbating housing and economic insecurity.

Policymakers Can Ensure All Older Adults Have a Home

Older Californians are neighbors, parents, grandparents, and invaluable members of our communities who deserve access to an affordable, accessible, and dignified place to call home, regardless of their background or ability. As state and federal policymakers consider choices that will affect California’s unhoused and vulnerable communities, it is important to understand the unique housing, economic, and health conditions older unhoused adults face. By doing so, policymakers can act on proven policies and interventions that can help solve homelessness among older adults, including:

  • Increasing affordable rental housing and supportive housing to ensure that all Californians have access to an affordable home that is designed to meet the needs of diverse types of households, including older adults, single workers, and people with disabilities.
  • Expanding and targeting additional financial support for Californians without dependents, low incomes, and disabilities through boosting Supplemental Security Income/State Supplementary Payment, General Assistance, and refundable tax credits.
  • Directing resources for rental assistance and homelessness services, including emergency and shallow rental subsidies, housing vouchers, and rapid-rehousing efforts to ensure people can remain in their homes during times of financial crisis or quickly exit homelessness.
  • Continuing to strengthen California's aging network and initiatives to connect housing and healthcare systems by leveraging efforts such as CalAIM housing supports and California’s Master Plan on Aging.
  • Protecting renters through expanding, enforcing, and funding legal aid and eviction protections.

Policymakers can work towards a California where experiencing homelessness is a brief and rare occurrence, and where everyone has a safe and stable home.

Health & Safety Net
  • 1
    Adults without children, also referred to as single adults, are categorized by the US Department of Housing and Urban Development as being age 25 and over. This includes sole individuals, adult couples with no children, groups of adults, and may capture noncustodial parents. Sole individuals ages 18 to 24 are considered unaccompanied  youth. The terms homeless and unhoused are also used interchangeably.
  • 2
    For more on the shortfalls of safety net programs for low-income non-elderly adults see: Joseph Llobrera et al., A Frayed and Fragmented System of Supports for Low-Income Adults Without Minor Children (Center on Budget and Policy Priorities, January 28, 2021), https://www.cbpp.org/research/a-frayed-and-fragmented-system-of-supports-for-low-income-adults-without-minor-children#state-general-assistance-programs-provide-cbpp-anchor.
  • 3
    General Assistance/General Relief which is a state-mandated program that counties must offer to indigent adults. Each California county administers and fully funds its own program and sets their own benefits, payment levels, and eligibility requirements.
  • 4
    For more see: Danyelle Solomon, Connor Maxwell, and Abril Castro, Systemic Inequality: Displacement, Exclusion, and Segregation: How America's Housing System Undermines Wealth Building in Communities of Color (Center for American Progress, August 7, 2019),  https://www.americanprogress.org/article/systemic-inequality-displacement-exclusion-segregation/ and California Department of Justice, California Task Force to Study and Develop Reparation Proposals for African Americans, The California Reparations Report (2023), https://oag.ca.gov/ab3121/report.

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key takeaway

California’s universal school meal program ensures all students have access to nutritious meals at school regardless of family income. This program combats childhood hunger, simplifies administration for schools, and has inspired similar initiatives in other states.

No child in California should go hungry. While families across the country face significant price increases in groceries and other basic needs, California schools have played a central role in making sure that children have access to nutritious meals regardless of their families’ income level. 

In the 2022-23 school year, California became the first state to provide free school meals to any child regardless of whether they were eligible for the free or reduced-price meals as defined by the federal government. Since then, seven other states have passed similar policies, recognizing the benefits universal school meals provide to families and schools. 

California policymakers should continue to protect universal school meal programs to support children’s health and well-being. Limiting free school lunches to families who meet a certain income threshold would be harmful to children’s health and would also increase the administrative burden for schools.

WHat is food insecurity?

Food insecurity is a household-level economic and social condition of limited or uncertain access to adequate food. In contrast, food security is when all people have access to enough food for an active, healthy life at all times.

1. Reverting to the Federal School Meal Program Would Exclude Many Families Facing Food Insecurity

The California Universal School Meals Program (UMP) has expanded access to school meals to all children, well beyond what the federal government requires. The National School Lunch Program (NSLP) and School Breakfast Program (SBP), the two federally funded school meal programs, cap income eligibility at 130% and 185% of the federal poverty line (FPL), respectively. In California, that would mean that a family of four must have a total income of at most $39,000 for the children to qualify for free school meals and at most $55,500 to qualify for reduced-price meals in the current school year. However, 44% of food-insecure families in California had incomes above 185% of the FPL in 2022.1Based on Budget Center analysis of US Census Bureau, Current Population Survey for 2022 downloaded from IPUMS. As shown in the chart below, families with incomes above the threshold experience varying degrees of food insecurity.

2. The California Universal Meals Program Can Help Reduce Child Hunger

Income is not a perfect measure of whether a child is food insecure because family circumstances can change, and often do, particularly in a state with a high cost of living like California. In a 2022 survey, parents reported that the UMP has saved them money and time as well as reduced family stress. The UMP has ensured that no child has to worry about where their next meal will come from, regardless of their family situation.

3. School Meals Support Children’s Health and Learning

School meals promote good nutrition and improve health and learning, according to research. Children who participate in school meal programs are more likely to consume fruits, vegetables, and milk at breakfast and lunch, reducing the risk of nutrient deficiencies which can be harmful to health. These programs are also instrumental in supporting students’ health and well-being, with studies showing that free or reduced-price school lunches help lower rates of poor health and obesity. In addition, research shows that school meal programs help students learn and succeed in school through improved attendance, student behavior, academic performance, and long-term educational attainment.

4. The Universal School Meals Program Reduces Stigma Around Free Meals

Moving away from a means-tested approach reduces stigma around free meals, which helps the program reach more students. Research has shown that reducing the stigma associated with means-tested programs increases participation. The UMP has been successful in increasing breakfast and lunch participation as well as reducing the stigma around free school meals and unpaid meal debt. When food access is not tied to poverty status, students are less likely to shy away from grabbing a meal if they need one.

5. The Universal Meals Program Reduces Administrative Burden On Schools

The UMP reduces meal debt by making all school meals free to students. Schools are required to take on extra administrative tasks to account for meal debt, which, according to the California Department of Education (CDE), include collecting and documenting:

  • Evidence of efforts to collect unpaid meal charges in accordance with the CDE or local unpaid meal charge policy; 
  • Financial documentation showing when the unpaid meal charges became an operating loss; and 
  • Documentation showing when the repayment plan was agreed to by all parties.

Additionally, meal debt is an operating loss for schools. Thus, without UMP, school districts would likely face challenges with both the financial and administrative burdens of increased meal debt.

The UMP requires high-poverty schools to participate in the Community Eligibility Provision (CEP), which significantly reduces school meal administrative burden. CEP is a federal program that provides alternate meal counting and collection procedures. Namely, CEP schools do not collect meal applications, do not conduct verification activities, and do not classify meals as free, reduced-price, or paid. As a result, school meal administration is far less burdensome and many overhead costs are eliminated. Before the UMP requirement, only 24 percent of schools participated in CEP. 

what is meal debt?

Meal debt occurs when students who are not certified to receive free school meals do not have enough cash in hand or in their school meals account to pay for their meals or for the “reduced-price” copayment. School districts set their own policy for unpaid school meal fees.

As of the 2022-23 school year, participation increased to 51 percent, prompted by the onset of UMP. However, as part of the CEP application, California schools must calculate an identified student percentage (ISP) reflecting the proportion of students that are directly certified for meals at no cost on the basis of their participation in safety net programs (i.e., CalFresh and CalWORKs) and other characteristics (such as foster youth). Some California schools face challenges with correctly calculating the ISP and are therefore not able to fully maximize the federal benefit.  Therefore, with UMP and its associated CEP participation requirement, more schools may benefit from the administrative efficiency that comes with program participation but additional technical assistance from CDE could ensure schools maximize benefits from CEP participation.

California should continue to lead the way in making sure any child who needs a meal can obtain one. The California Universal School Meals Program not only supports family and child well-being and effective school administration, but it also may promote cost savings if the state can maximize the number of meals federally reimbursed at the free rate. State policymakers should continue investing in this program to maximize federal reimbursements and ensure all children have access to high-quality nutritious meals. By making sure all children receive proper nutrition at school, state leaders can help alleviate food insecurity and support children’s health and well-being.

Health & Safety Net
  • 1
    Based on Budget Center analysis of US Census Bureau, Current Population Survey for 2022 downloaded from IPUMS.

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