California’s 58 counties face an array of health care challenges — some new, some longstanding but about to grow. Realignment is shifting more responsibility for health care from state to county governments, a lingering recession is making it increasingly difficult to make budgets balance at every governmental level and big changes are under way as part of the Affordable Care Act. For years, California’s disparate county governments — as different and far removed from each other as some of the United States are from each other — have played a leading role in providing medical and mental health care for low-income, underserved and uninsured populations. That role — interpreted differently by each county using a patchwork of federal and state programs and funding — is about to become more complex, if not more difficult. The influx of millions of newly insured Californians along with added tasks from the state and what appears to be a long-term financial pinch make for rocky roads ahead.