California’s newly approved $352 billion budget has softened the immediate blow from President Trump’s cuts to federal healthcare and social programs. However, local governments, including Sonoma County, still face a multimillion-dollar problem next year.
The state budget includes $250 million for public hospitals and $420 million to maintain and bolster enrollment in healthcare and food benefits. The budget’s passage means Sonoma County could recoup at least some of the $9.7 million the Board of Supervisors set aside in June to hire 38 more enrollment specialists with the aim of keeping as many people enrolled in federal and state benefits as possible.
But the state budget won’t help cover the cost of providing mandated emergency healthcare – indigent care – for those expected to lose their medical coverage. Sonoma County leaders won’t know the true cost of providing such care until next year when the majority of changes in Trump’s One Big Beautiful Bill, or HR1, kick in.
The California Association of Counties, along with other statewide county advocacy groups, asked for $50 million to cover indigent care costs in the fiscal year that began Wednesday, July 1, and sought $462 million in the 2027-28 fiscal year. It got $0 in the state budget approved this week.
Advocates are now pressing state legislators and the governor to commit additional dollars for indigent care services before the Legislature adjourns in August.
“There is zero in the state budget related to indigent care,” said Graham Knaus, chief executive officer of CSAC. “But we know there will be hundreds of thousands, if not a million-plus Californians that are going to lose coverage and have nowhere to go.”
He said counties are thankful for the state funding for public hospitals and eligibility workers, but described the budget as a “well-baked half-a-loaf” that does not address the full impacts of HR1.
The state budget aligns with what Sonoma County officials anticipated, and at least blunts the immediate impacts until next year, according to County Executive David Guhin.
“We went into our budget process assuming that there would be no additional funding around (indigent care) and so our approach stays the same,” Guhin said.
Considered the largest cut to safety-net programs in American history, HR1 includes a $1 trillion reduction to Medicaid, the federal healthcare coverage program for low-income individuals and families and disabled people, lower reimbursements for hospitals, stiffer eligibility requirements for aid recipients and a deep cut to the federal food assistance program.
“HR1 is an intentional way to kick eligible people off of federally mandated services and leave communities to fend for themselves,” Knaus said. “We’re thankful for the modest investment that the Legislature and governor have made and need the same to occur in indigent care.”
In May, Sonoma County officials estimated it would cost $39.6 million to cover indigent care costs for three years. That figure includes funding for community health clinics tasked with providing care for the newly uninsured and those who qualify for a basic “life and limb” healthcare program called the County Medical Services Program, or CMSP.
Prior to the implementation of the Affordable Care Act in 2014, CMSP was for many counties the healthcare safety net for those who did not qualify for Medi-Cal, the state’s version of the federal Medicaid program.
In Sonoma County, 97 people currently rely on CMSP for basic healthcare but estimates released in April showed that number could balloon to 11,560.
The cost of building the program up to meet that demand would be astronomical, officials have said. For now, the CMSP governing board has pledged to tap its reserves to cover the current year’s costs.
Local clinics bracing for a wave of uninsured patients have asked Sonoma County for $12 million to help meet the need, but officials are holding off on committing dollars. The county won’t have to deal with the brunt of these costs at least for another year when the majority of HR1 changes take effect, said Guhin.
You can reach Staff Writer Emma Murphy at 707-521-5228 or emma.murphy@pressdemocrat.com.
You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com