An April report released by the California Health Care Foundation found that Riverside and San Bernardino counties continue to lag slightly behind much of California in overall health outcomes, income levels and access to medical care, even as the region has made progress in expanding physician availability.

    The nonprofit foundation, which focuses on improving healthcare access across California, reported that about four in every 10 Inland Empire residents are insured through Medi-Cal, California’s version of the federal Medicaid program serving low-income and disabled residents.

    That translates to roughly 1.88 million people — a population large enough to cover more than two-thirds of the city of Chicago.

    The report also found that 8% of Inland Empire residents remained uninsured in 2023, compared to the statewide average of 6.4%.

    Healthcare officials say the region’s heavy dependence on Medi-Cal leaves local hospitals and healthcare providers especially vulnerable to federal Medicaid funding reductions approved last year.

    Researchers warned those cuts could threaten recent gains made in improving healthcare access throughout the Inland Empire.

    Health outcomes in the region also continue to trail statewide averages in several categories.

    According to the report, approximately 16% of Inland residents described their health as fair or poor, slightly higher than California’s statewide average of 15.5%.

    The Inland Empire’s infant mortality rate was also higher than the state average, with 5 infant deaths per 1,000 live births compared to California’s rate of 4.1 per 1,000.

    Economic disparities remain another challenge tied closely to healthcare access. The report found the Inland Empire’s median household income sits roughly $10,000 below the statewide average, while fewer local households earn more than $100,000 annually compared to the rest of California.

    One area showing improvement is physician availability.

    Between 2015 and 2023, the number of primary care doctors per 100,000 Inland residents increased by 20%, while specialty physician numbers climbed 38%.

    Even with that growth, the Inland Empire still falls well short of the statewide average when it comes to physician availability. The region currently has about 229 doctors per 100,000 residents, compared to California’s average of 358 physicians per 100,000 people.

    The report also highlighted gaps in representation within the medical field itself. While Latinos make up more than half of the population in Riverside and San Bernardino counties, only about 10% of doctors practicing in the Inland Empire are Latino.

    UC Riverside School of Medicine has been working to address the physician shortage since opening in 2013. School officials say the strategy has focused heavily on recruiting students with local ties in hopes they will remain in the region long term.

    Dr. Daniel Teraguchi, executive associate dean for student affairs at the medical school, said 80% of incoming students have connections to the Inland Empire. He added that 51% of students who match with residency programs are staying in the region to complete their training.

    “Because they’re training here, it’s likely those future doctors will stay in the Inland Empire,” Teraguchi said.

    The report also examined hospitals throughout the region. Researchers found the Inland Empire’s healthcare market remains relatively competitive compared to other parts of California, with roughly 40 hospitals serving the two-county area.

    However, the region still has fewer hospital beds available than the statewide average. The Inland Empire averages about 173 beds per 100,000 residents, compared to California’s statewide average of 198 beds per 100,000.

    Researchers noted that while many hospitals remain financially stable, several are facing mounting economic pressure and have already begun reducing services, including maternity care programs.

    Public hospitals continue to play a major role in the region’s healthcare safety net, particularly Riverside University Health System Medical Center in Moreno Valley and Arrowhead Regional Medical Center in Colton.

    Michelle Decker, president and CEO of the Inland Empire Community Foundation, said the report accurately reflects both the progress and ongoing concerns facing healthcare providers in the region.

    “It captures how current federal policies clearly threaten those gains without providing any new ideas or money to improve the health of IE residents,” Decker said in an email statement.

    Decker called for increased public investment, stronger collaboration and innovative partnerships between hospitals, businesses, nonprofits, governments and community organizations.

    “We won’t weather this moment if we work in silos, and we need innovation to come from all corners,” she said.

    She warned that without action, Inland Empire residents could face setbacks in healthcare access at a time when many families are already struggling financially.

    “It’s clear from the data that the people who live in the IE cannot afford to see a steep slide backwards in health care,” Decker said.

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The lawsuit, filed in the U.S. District Court for the District of Massachusetts, targets a January executive order that makes it U.S. policy not to “fund, sponsor, promote, assist, or support” gender transition for people under 19. The order threatens to pull federal funding from medical institutions that provide this type of care. 

“The result is an atmosphere of fear and intimidation experienced by transgender individuals, their families and caregivers, and the medical professionals who seek only to provide necessary, lawful care to their patients,” the attorneys general wrote in the suit.

This marks the 37th lawsuit California has filed against the Trump administration.

Gender-affirming care is legal and protected for people 18 years old and older in California. Certain treatments are also available to younger people with parental consent. The lawsuit comes as some of the largest medical providers in the state halt gender-affirming services.

The Trump administration has “trampled over state rights, overstepped their constitutional authority and endangered vulnerable minors and 18-year-olds,” Bonta said in a Friday press conference announcing the lawsuit alongside the attorneys general of Illinois and Connecticut. 

Providers scale back care

Following Trump’s executive order, the U.S. Department of Justice directed employees to investigate doctors, hospitals and pharmaceutical companies that provided gender-affirming care. In July, U.S. Attorney General Pamela Bondi announced in a statement that her department had issued more than 20 subpoenas to medical providers as it investigates “healthcare fraud, false statements and more.”

Responding to the suit, DOJ spokesperson Natalie Baldassarre said, “As Attorney General Bondi has made clear, this Department of Justice will use every legal and law enforcement tool available to protect innocent children from being mutilated under the guise of ‘care.’”

Bonta said that providers, fearing prosecution, have scaled back on providing gender-affirming care, which has left many patients without critical medical care, Bonta said. The care includes hormone therapy, puberty blockers and surgical procedures. Research shows that gender-affirming care can positively impact the mental health of transgender youth. Forcing young people to wait until they are 19 or older to start care allows symptoms of gender dysphoria to worsen, Bonta said.

The state attorneys general argue that acceding to Trump’s orders puts providers at odds with states’ anti-discrimination and age-of-majority laws. In California, it is illegal to deny care on the basis of gender identity and gender expression. At the same time, many medical providers rely heavily on federal funding in the form of research and education grants, as well as reimbursements from public payer programs like Medi-Cal.

The directives from the Trump administration have already forced several providers to suspend services. Last month, Children’s Hospital Los Angeles closed its gender-affirming care center, forcing about 3,000 patients under 21 to look elsewhere for care. 

“The shutdown came despite efforts my office took over recent months to assure (Children’s Hospital Los Angeles) that they were protected and required to provide gender-affirming care,” Bonta said.

Stanford Medicine has also paused surgical procedures for people under 19. And this week, Kaiser Permanente announced that it too would pause gender-affirming surgeries starting Aug. 29, noting that hormone therapies would still be available. 

The executive order being challenged is just one of several that Trump has issued targeting transgender people. Others include one that recognizes only two biological sexes, a second that prevents transgender girls and women from participating in women’s sports, and a third that threatens federal funds for schools that support transgender youth.

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RIVERSIDE COUNTY, CA — A proposed county-operated $580 million wellness center received final approval Tuesday from the Riverside County Board of Supervisors.

With the signoff, construction of the 19.4-acre Riverside University Health System’s Wellness Village campus will begin in June at the intersection of Harvill and Placentia avenues in Mead Valley.

Slated for completion in 2026, the village will offer primary and specialty medical care, dental services, substance use disorder services, and a pharmacy, as well as onsite respite for families.

A crisis residential behavioral health center for children and a Children’s Mental Health Urgent Care—both firsts in Riverside County — are planned, as are social services such as WIC, job training and educational services.

“This project is unlike anything else that’s been done. It will be a place where individuals of all ages can access a range of services in an environment designed to foster healing, community interaction and overall wellbeing,” said Dr. Matthew Chang, Behavioral Health Director for RUHS. “In terms of behavioral health treatment approaches, we are breaking new ground.”

First District Supervisor Kevin Jeffries said the RUHS Wellness Village represents a major shift in healthcare delivery and will serve as a model for the state.

“By centralizing and enhancing access to healthcare, such as pediatric behavioral health services, we’re ensuring that families no longer need to travel out of county for essential care,” Jeffries said.

The project is expected to create hundreds of permanent jobs and generate millions of dollars in taxes and spending, according to county officials.

The center is being developed in partnership with a nonprofit corporation — P3 Riverside Holdings, LLC. The financing plan includes the issuance of tax-exempt bonds and the county entering into a long-term ground lease and facilities agreement with the nonprofit.

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