The county government is often the place of last resort for the medically indigent in California. Some counties run hospitals and/or clinics to care for these individuals outside of the Medicaid system. Other counties operate their own HMO to cover Medicaid patients. As I previously described, there are three types of private Medi-Cal HMO systems that California counties can adopt: Geographic Managed Care, County-Organized Health System, and Two Plan Counties. In many of these systems, counties operate their own Medicaid HMO.