In July 1997, the Board of Directors of the Robert Wood Johnson Foundation (RWJF) authorized $16.8 million to support Communities in Charge: Financing and Delivering Health Care to the Uninsured. Communities in Charge is a program to help broad-based community coalitions design and establish sustainable health care delivery systems that manage health care services for uninsured residents, promote prevention and early intervention and integrate health care services.

Twenty communities received funds to plan and design new health care finance and service delivery strategies, and 14 of these communities received additional funds to implement the strategies they designed. Medimetrix, a for-profit health consulting firm located in Cleveland, was the national program office (NPO) and provided both group and site-specific technical assistance throughout the program.

Key Results
The NPO reported the following among its overall program results:

• Nine project sites enrolled more than 30,000 people in new or expanded coverage/access programs that ranged from new insurance programs to programs in which providers delivered care on a voluntary basis.
• Eight project sites created new case management or disease management programs to better coordinate and meet the needs of low-income uninsured people.
• Ten sites enrolled more than 50,000 individuals in public health insurance programs, both Medicaid and the State Children's Health Insurance Programs.
• Several communities created new infrastructure to better serve low-income and indigent clients.
• Participating communities leveraged more than $80 million in new funds.
• Alameda County (Calif.) and Austin (Texas) raised new taxes to finance indigent care.

Key Evaluation Findings
The program's independent program evaluators reported:

• Enrollment programs offering coverage or access to care, while small, did improve access to health care services and preventive care for their enrollees.
• Successful program initiation is most likely to occur when provider organizations are experiencing significant financial stress as a result of uncompensated care, but are not so concerned about revenue sources that they cannot afford to participate.
• In general, communities do not have the capacity to tackle the problems of the uninsured. Even local leaders who are dedicated to addressing the problem face an uphill struggle in trying to remake the safety-net insurance system.