FRESNO COUNTY – In the face of a projected shortfall of millions of dollars, Fresno County has joined the California State Association of Counties to call on the state government to fund a multi-billion dollar, multi-year budget request.

In a March 26 press release, Fresno County announced it is calling for immediate action by the state to fund the request put forward by CSAC. The association of counties is asking for a statewide allocation of $1.9 billion in fiscal year 2026-27, which begins on July 1, and $4.5 billion in fiscal year 2027-28 to assist counties with carrying out safety-net services including health care and CalFresh benefits. 

“Fresno County is ground zero for the impacts of HR 1,” County Administrative Officer Paul Nerland said in the press release. “The state must act now to provide sustainable funding or counties will be forced into decisions that put critical services at risk.” 

House Resolution (HR) 1 is the One Big, Beautiful Bill Act signed into law in July 2025. The legislation made numerous federal policy changes, including a reduction in how much the federal government would pay for its share of social services programs like Medicaid and Supplemental Nutrition Assistance Program (SNAP) benefits. 

By shifting more of the cost burden to states, the federal legislation also put that burden onto California’s counties, which act as the administrative arm of many of these programs. 

The exact impact of these changes is still uncertain, but according to an analysis conducted by Fresno County staff, the annual increase in costs incurred by the county could be between $68.5 and $294.5 million.

These costs are tied to indigent health care, county behavioral health services and increased administrative duties mandated by HR 1. 

A CSAC press release from March 24 said if the state forces counties to absorb these impacts alone, there will be “no choice” but to cut core services that residents rely on daily, including public safety, homelessness programs, election administration and more. 

This is because counties administer the state’s most vital programs, the press release said, but lack the authority to absorb major funding shortfalls. Fresno County must have a balanced budget every year, and it also must administer these programs, which means funding for other county activities would have to be cut. 

“It is essential for the governor’s updated May Revision budget proposal to support counties in addressing this crisis, as millions of Californians will be affected,” the press release said. 

Indigent health care

The CSAC budget request is split up into four categories. Of the $1.9 billion requested for fiscal year 2026-27, California counties are asking for $224 million to fund behavioral health services, $373 million to support the implementation of new eligibility requirements for Medi-Cal and CalFresh, $500 million for public hospital systems and $761 million for indigent care. 

The fiscal year 2027-28 $4.5 billion request is divided into $828 million for behavioral health, $402 million for eligibility requirements, $850 million for public hospital systems and $2.4 billion for indigent care. 

Funding for indigent care makes up nearly half of the total $6.4 billion two-year budget request because counties are mandated to provide indigent care and currently receive no state funding to do so. 

“In addition to the impacts of HR 1 on Fresno County, the state has imposed mandates without providing the funding to meet them,” Board Chair Garry Bredefeld said in the press release. “That approach is not sustainable. Counties cannot continue to shoulder the burden of unfunded state requirements while trying to maintain essential services for our communities.”

Indigent care programs assist low-income residents who have a medical need but have no source of health coverage available and no other way to pay for necessary medical care. Analysis of the impacts of HR 1 by CSAC estimate that a large number of Californians who lose Medi-Cal eligibility will seek county indigent care because they will have no other way to receive health care coverage.

CSAC specifically estimates that approximately 880,000 people who lose Medi-Cal coverage due to work requirements in HR 1 would have no health care coverage, and counties would then provide indigent care services to approximately 417,000 people.