San Diego County supervisors are pressing forward with potential changes to an obscure county-run program that labor unions want to fund with a new sales tax hike.
They could bring an overhaul of eligibility for a county program that pays for health care for certain low-income residents deemed “medically indigent” — the most restrictive such program among California’s biggest counties.
State law requires counties to operate and fund such programs to subsidize care for low-income people who don’t qualify for other programs like Medi-Cal. But San Diego County’s has long come with restrictions that others lack.
To enroll in County Medical Services, participants must have a lien put on their home and must be U.S. citizens. Many other counties — including Los Angeles, San Francisco and Sacramento — don’t consider immigration status.
“Our antiquated CMS system is not a badge of pride,” said Supervisor Monica Montgomery Steppe. “Today’s action ensures we are rebuilding a system that is equitable, accessible and responsive.”
At a meeting on Tuesday, supervisors voted to direct staff to explore making changes to the program’s eligibility criteria as well as how to publicize it more in the community.
County staff will have to bring back recommended updates to the program two months after passage of the county’s 2026-2027 budget, which supervisors adopt in the summer.
Supervisor Jim Desmond cast the lone vote against the item, saying he wanted more feedback from staff about potential changes.
Medically indigent programs had far more relevance in California prior to the passage of the Affordable Care Act, or Obamacare.
Enrollment in the county’s program peaked at 40,000 in 2013 when Obamacare enrollment first opened, said Tim McClain, a spokesperson for the county’s Health and Human Services Agency, which administers the program.
In the county’s most recent fiscal year, a cumulative total of only 39 people were ever enrolled in County Medical Services for any length of time. About two people are typically enrolled at any given time, according to county data.
In that most recent year, the county spent $970,000 on the program — the vast majority of it on administration. Just $200,000 of that was spent on actual patient care.
County Medical Services is among a host of programs that could be funded by a new sales tax surcharge that a coalition of labor unions and nonprofit leaders are hoping to get on the November ballot. They’re currently gathering signatures.
Organizers expect such a half-cent sales tax hike, if passed, to bring in $360 million in its first year. Of that, $4 million would go to County Medical Services, according to papers they filed.
The citizen-led ballot initiative is being led by SEIU 221, the largest labor union for county workers, along with the county firefighters’ union and a political action committee helmed by leaders of two of the region’s biggest social services providers.
Even though labor unions want more money for the program, efforts from supervisors to reform County Medical Services emerged from a consultant the county hired, said Supervisor Terra Lawson-Remer.
In January, supervisors hired Precision Health Strategies, a firm led by former state Medicaid director Jacey Cooper, to advise them on possible changes to county medical programs. Cooper will be paid $45,000, according to the contract.