District hospitals, with publicly elected Boards of Directors, are local governments responsible for providing for the healthcare needs of their communities. Healthcare districts began to be formed in 1946 and 1947 in response to California’s acute care bed shortage after World War II. Today these healthcare districts are still relied upon as the healthcare access points in many of California’s counties. California’s public district hospitals provide significant levels of care to the uninsured and Medi-Cal populations. In 19 counties, district hospitals are the only public hospitals within the county. In addition, many of the local residents in the other 9 counties that contain both public district hospitals along with either a county or University of California hospital there is a significant geographic separation that limits the beneficiaries option of seeking care at any other acute care hospital other than the public district hospital. The DHLF seeks to work toward a remedy to expand access to needed hospital services for all Californians, especially low-income patients, across the state.